CASE STUDY OF ASTHMA

Asthma is a chronic, reversible, obstructive airway disease, characterized by wheezing. It

is caused by a spasm of the bronchial tubes, or the swelling of the bronchial mucosa, after
exposure to various stimuli.

Asthma is the most common chronic disease in childhood. Most children experience their
first symptoms by 5 years of age.

ETIOLOGY:

Asthma commonly results from hyperresponsiveness of the trachea and bronchi to

irritants. Allergy influences both the persistence and the severity of asthma, and atopy or
the genetic predisposition for the development of an IgE-mediated response to common
airborne allergens is the most predisposing factor for the development of asthma.

CLASSIFICATION:

1. Extrinsic Asthma – called Atopic/allergic asthma. An “allergen” or an “antigen” is a

foreign particle which enters the body. Our immune system over-reacts to these often
harmless items, forming “antibodies” which are normally used to attack viruses or
bacteria. Mast cells release these antibodies as well as other chemicals to defend the
body.

Common irritants:

• Cockroach particles
• Cat hair and saliva
• Dog hair and saliva
• House dust mites
• Mold or yeast spores
• Metabisulfite, used as a preservative in many beverages and some foods
• Pollen
2. Intrinsic asthma – called non-allergic asthma, is not allergy-related, in fact it is
caused by anything except an allergy. It may be caused by inhalation of chemicals such as
cigarette smoke or cleaning agents, taking aspirin, a chest infection, stress, laughter,
exercise, cold air, food preservatives or a myriad of other factors.

• Smoke
• Exercise
• Gas, wood, coal, and kerosene heating units
• Natural gas, propane, or kerosene used as cooking fuel
• Fumes
• Smog
• Viral respiratory infections
• Wood smoke
• Weather changes

ANATOMY AND PHYSIOLOGY:

The upper respiratory tract consists of the nose, sinuses,

pharynx, larynx, trachea, and epiglottis.

The lower respiratory tract consist of the bronchi, bronchioles and the lungs.

The major function of the respiratory system is to deliver oxygen to arterial blood and
remove carbon dioxide from venous blood, a process known as gas exchange.

The normal gas exchange depends on three process:

• Ventilation – is movement of gases from the atmosphere into and out of the
lungs. This is accomplished through the mechanical acts of inspiration and
expiration.
• Diffusion – is a movement of inhaled gases in the alveoli and across the alveolar
capillary membrane
• Perfusion – is movement of oxygenated blood from the lungs to the tissues.

Control of gas exchange – involves neural and chemical process

The neural system, composed of three parts located in the pons, medulla and spinal cord,
coordinates respiratory rhythm and regulates the depth of respirations

The chemical processes perform several vital functions such as:

• regulating alveolar ventilation by maintaining normal blood gas tension

• guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia
(reduced tissue oxygenation caused by decreased arterial oxygen [PaO2]. An
 increase in arterial CO2 (PaCO2) stimulates ventilation; conversely, a decrease in
PaCO2 inhibits ventilation.
• helping to maintain respirations (through peripheral chemoreceptors) when
hypoxia occurs.

The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar
in children and adults. however, children respond differently than adults to respiratory
disturbances; major areas of difference include:

• Poor tolerance of nasal congestion, especially in infants who are obligatory nose
breathers up to 4 months of age
• Increased susceptibility to ear infection due to shorter, broader, and more
horizontally positioned eustachian tubes.
• Increased severity or respiratory symptoms due to smaller airway diameters
• A total body response to respiratory infection, with such symptoms as fever,
vomiting and diarrhea.

SIGNS AND SYMPTOMS:

1. Non Productive to Productive Cough

2. Dyspnea
3. Wheezing on expiration
4. Cyanosis
5. Mild apprehension and restlessness
6. Tachycardia and palpitation
7. Diaphoresis

PATHOPHYSIOLOGY:

CLINICAL MANIFESTATIONS:

1. Increased respiratory rate

2. Wheezing (intensifies as attack progresses)
3. Cough (productive)
4. Use of accessory muscles
5. Distant breath sounds
6. Fatigue
7. Moist skin
8. Anxiety and apprehension
9. Dyspnea

Steps of Clinical and Diagnostic as per National Asthma Education and Prevention
Program

Mild Intermittent Asthma

 • Symptoms ? 2 times per week
• Brief exacerbations
• Nighttime symptoms ? 2 times a month
• Asymptomatic and normal PEF (peak expiratory flow) between exacerbations
• PEF or FEV, (forced expiratory volume in 1 second) ? 80% of predicted value
• PEF variability < 20%

Mild Persistent Asthma

• Symptoms > 2 times/week, but less than once a day

• Exacerbations may affect activity
• Nighttimes symptoms > 2 times a month
• PEF/FEV ? 80% of predicted value
• PEF variability 20%-30%

Moderate Persistent Asthma

• Daily Symptoms
• Daily use of inhaled short-acting ?2 - agonists
• Exacerbations affect activity
• Exacerbations ? 2 times a week
• Exacerbations may last days
• Nighttime symptoms > once a week
• PEF/FEV > 60%-<80% of predicted value
• PEF variability > 30%

Severe Persistent Asthma

• Continual symptoms
• Frequent exacerbations
• Frequent nighttime symptoms
• Limited physical activity
• PEF or FEV ? 60% of predicted value
• PEF variability > 30 %

LABORATORY AND DIAGNOSTIC FINDINGS:

Spirometry will detect:

a. Decreased for expiratory volume (FEV)

b. Decreased peak expiratory flow rate (PEFR)

c. Diminished forced vital capacity (FVC)

d. Diminished inspiratory capacity (IC)

NURSING MANAGEMENT:

1. Assess respiratory status by closely evaluating breathing patterns and monitoring vital
signs

2. Administer prescribed medications, such as bronchodilators, anti-inflammatories, and

antibiotics

3. Promote adequate oxygenation and a normal breathing pattern

4. Explain the possible use of hyposensitization therapy

5. Help the child cope with poor self-esteem by encouraging him to ventilate feelings and
concerns. Listen actively as the child speaks, focus on the child’s strengths, and help him
to identify the positive and negative aspects of his situation.

6. Discuss the need for periodic PFTs to evaluate and guide therapy and to monitor the
course of the illness.

7. Provide child and family teaching. Assist the child and family to name signs and
symptoms of an acute attack and appropriate treatment measures

8. Refer the family to appropriate community agencies for assistance.

Bronchial Asthma Is a chronic inflammatory disease of the airways, associated with

recurrent, reversible airway obstruction with intermittent episodes of wheezing and dyspnea.
Bronchial hypersensitivity is caused by various stimuli, which innervate the vagus nerve
and beta adrenergic receptor cells of the airways, leading to bronchial smooth muscle
constriction, hypersecretion of mucus, and mucosal edema.

The symptoms of bronchial asthma includes:

• a feeling of tightness in the chest;

• difficulty in breathing or shortness of breath;
 • wheezing; and
• coughing (particularly at night).

Asthma triggers may include:

• Tobacco smoke
• Infections such as colds, flu, or pneumonia
• Allergens such as food, pollen, mold, dust mites, and pet dander
• Exercise
• Air pollution and toxins
• Weather, especially extreme changes in temperature
• Drugs (such as aspirin, NSAID, and beta-blockers)
• Food additives (such as MSG)
• Emotional stress and anxiety
• Singing, laughing, or crying
• Smoking, perfumes, or sprays
• Acid reflux