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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
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
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 %
Diagnostic test

Spirometry, which measures how much air you are able to move in
and out of your lungs. This easy, painless, and noninvasive breathing test
is often done regularly to monitor how well treatments are working.

Spirometry will detect:


a. Decreased for expiratory volume (FEV) (forced expiratory volume)
b. Decreased peak expiratory flow rate (PEFR) (peak expiratory flow)
c. Diminished forced vital capacity (FVC)
d. Diminished inspiratory capacity (IC)
Chest X-ray may be done, which can evaluate a number of factors,
including the presence of other conditions that may occur with or without
asthma symptoms, such as pneumonia, and bronchitis. A
bronchoprovocation test may also be performed to measure lung function
after a variety of factors that potentially provoke asthma symptoms are
introduced to the patient.

Allergy testing is also commonly performed to determine a person's


individual sensitivities to allergens, substances that trigger an allergic
reaction that can result in asthma symptoms.

Treatment of Asthma
Asthma cannot be cured, but it can be controlled with proper asthma
management.
The first step in asthma management is environmental control.
Asthmatics cannot escape the environment, but through some changes,
they can control its impact on their health.
Listed below are some ways to change the environment in order to lessen
the chance of an asthma attack:
• Clean the house at least once a week and wear a mask while doing
it
• Avoid pets with fur or feathers
• Wash the bedding (sheets, pillow cases, mattress pads) weekly in
hot water
• Encase the mattress, pillows and box springs in dust-proof covers
• Replace bedding made of down, kapok or foam rubber with
synthetic materials
• Consider replacing upholstered furniture with leather or vinyl
• Consider replacing carpeting with hardwood floors or tile
• Use the air conditioner
• Keep the humidity in the house low
The second step is to monitor lung function. Asthmatics use a peak
flow meter to gauge their lung function. Lung function decreases before
symptoms of an asthma attack - usually about two to three days prior. If
the meter indicates the peak flow is down by 20 percent or more from
your usual best effort, an asthma attack is on its way.
The third step in managing asthma involves the use of
medications. There are two major groups of medications used in
controlling asthma - anti-inflammatories (corticosteroids) and
bronchodilators.
Anti-inflammatories reduce the number of inflammatory cells in the
airways and prevent blood vessels from leaking fluid into the airway
tissues. By reducing inflammation, they reduce the spontaneous spasm of
the airway muscle. Anti-inflammatories are used as a preventive measure
to lessen the risk of acute asthma attacks. The corticosteroids are given in
two ways - inhaled via a metered dose inhaler (MDI) or orally via pill/tablet
or liquid form. The inhaled corticosteroids are flunisolide (AeroBid),
triamcinolone (Azmacort) and beclomethasone (Beclovent and Vaceril).
The oral corticosteroids (pill/tablet form) are prednisone (Deltasone,
Meticorten or Paracort), methylprednisolone (Medrol) and prednisolone
(Delta Cortef and Sterane). The oral corticosteroids (liquid form) are
Pedipred and Prelone. These liquid forms are used for asthmatic children.
Three drugs, zafirlukast (Accolate), montelukast (Singulair) and zileuton
(Zyflo), are part of a newer class of anti-inflammatories called
leukotriene modifiers. Taken orally, these drugs work by inhibiting
leukotrienes (fatty acids that mediate inflammation) from binding to
smooth muscle cells lining the airways. They also reduce the recruitment
of inflammatory cells to the airways. These drugs both prevent and reduce
symptoms, and are intended for long-term use.
Other inhaled anti-inflammatory drugs include cromolyn sodium (Intal)
and nedrocromil (Tilade).
Bronchodilators work by increasing the diameter of the air passages and
easing the flow of gases to and from the lungs. They come in two basic
forms - short-acting and long-acting. The short-acting bronchodilators are
metaproterenol (Alupent, Metaprel), ephedrine, terbutaline (Brethaire)
and albuterol (Proventil, Ventolin). These drugs are inhaled and are used
to relieve symptoms during acute asthma attacks. The long-acting
bronchodilators are salmeterol (Serevent), metaproterenol (Alupent), and
theophylline (Aerolate, Bronkodyl, Slo-phyllin, and Theo-Dur to name a
few). Serevent and Alupent are inhaled and theophylline is taken orally.
These drugs are sometimes used to control symptoms in special
circumstances, such as during sleep or when intensive exposure to a
particular irritant can be predicted (i.e. pollen season). Atrophine sulfate
(Atrovent) is another highly effective bronchodilator. This drug opens the
airways by blocking reflexes through nerves that control the bronchial
muscles.
Some people cannot control the symptoms by avoiding the triggers or
using medication. For these people, immunotherapy (allergy shots) may
help. Immunotherapy involves the injection of allergen extracts to
"desensitize" the person. The treatment begins with injections of a
solution of allergen given one to five times a week, with the strength
gradually increasing.
Note: Asthmatics vary considerably in their responses to different types,
combinations and amounts of medicines so therapy must be carefully
tailored to the individual. Even medication that may work well with some
asthmatics may not be effective for others. Please discuss your individual
situation with your doctor and both of you will determine a course of
management that is best for you.
Fast acting

Salbutamol metered dose inhaler commonly used to treat asthma


attacks.
• Short acting beta2-adrenoceptor agonists (SABA), such as
salbutamol (albuterol USAN) are the first line treatment for asthma
symptoms.

• Anticholinergic medications, such as ipratropium bromide provide


addition benefit when used in combination with SABA in those with
moderate or severe symptoms.

• Older, less selective adrenergic agonists, such as inhaled


epinephrine, have similar efficacy to SABAs. They are however not
recommended due to concerns regarding excessive cardiac
stimulation

Long term control


Fluticasone propionate metered dose inhaler commonly used for long
term control.
• Glucocorticoids are the most effective treatment available for long
term control. Inhaled forms are usually used except in the case of
severe persitent disease in which oral steroids may be needed. The
inhaled formulation may be used once or twice daily depending on
the severity of symptoms.

• Long acting beta-adrenoceptor agonists (LABD) have at least a 12-


hour effect. They are however not to be used without a steroid due
to an increased risk of severe symptoms. In December 2008,
members of the FDA's drug-safety office recommended withdrawing
approval for these medications in children. Discussion is ongoing
about their use in adults.

• Leukotriene antagonist ( such as zafirlukast) are an alternative to


inhaled glucocorticoids, but are not preferred. They may also be
used in addition to inhaled glucocorticoids but are second line to
LABD.

• Mast cell stabilizers ( such as cromolyn sodium) are another none


preferred alternative to glucocorticoids.

Prevention of Asthma
• Periodic assessments and ongoing monitoring of asthma are
essential to determine if therapy is adequate. Patients need to
understand how to use a peak flow meter and understand the
symptoms and signs of an asthma exacerbation.
• Regular follow-up visits (at least every six months) are important to
maintain asthma control and to reassess medication requirements.
• Patients with persistent asthma should be given an annual influenza
vaccine.
Nursing Diagnosis:
1. Ineffective airway clearance
2. Impaired gas exchange
3. Deficient knowledge (Learning Need) regarding condition, treatment
plan, self-care, and discharge need exchange
4. Risk for infection

GENERAL 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.
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
College of Nursing

Submitted by:

Airisse Angel D. Cortez


Robelrich Madrid
Cristina Ricardo
Raniel Joseph Santiago

Group 3
BSN IV-G

Submitted to:
Lester Bamba
Nico Elliah Bernardo
Head Nursing

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