GROUP 4

Presents
.

JHERIC SAN
BUENAVENTURA
(Leader)

DM PANO

RAI PALACIO

IRISH
VALDEZ

BRONCHIA
L ASTHMA
and
LUNG
CANCER

Bronchia
l Asthma

PATHOPHYSIOLOGY

NORMAL LUNG

DURING AN ASTHMA ATTACK

What triggers an attack?

Causes
The strongest risk factors for developing asthma are a combination
of genetic predisposition with environmental exposure to inhaled
substances and particles that may provoke allergic reactions or
irritate the airways, such as:
indoor allergens (for example, house dust mites in bedding,
carpets and stuffed furniture, pollution and pet dander)
outdoor allergens (such as pollens and moulds)
tobacco smoke
chemical irritants in the workplace
air pollution.
Other triggers can include cold air, extreme emotional arousal
such as anger or fear, and physical exercise. Even certain
medications can trigger asthma: aspirin and other non-steroid antiinflammatory drugs, and beta-blockers (which are used to treat
high blood pressure, heart conditions and migraine).

Asthma an allergic condition characterized

by spasms of the smooth muscles of the
bronchi and bronchioles due to edema and
overabundance of mucus.

Asthma attacks all age groups but often starts in

childhood.It isa disease characterized by
recurrent attacks of breathlessness and wheezing,
which vary in severity and frequency from person
to person. In an individual, they may occur from
hour to hour and day to day.

Signs and Symptoms

(due to altered respiratory function because

of increased airway resistance):

* Wheezing (due to obstruction to airflow in the bronchioles and smaller bronchi) on
expiration (expiration is prolonged because of the difficulty of breathing out air thru a
narrowed airway)
* Dyspnea; nose flaring; cyanosis; restlessness; fatigue; increased heart and
respiratory rates
*Secretions are thicker and more tenacious, especially in an anxious child
* Excessive perspiration; dilated neck veins
*Acid-base Imbalance (respiratory acidosis) due to impaired respirations and
increased formation of carbonic acid
* Increased Eosinophils count exact role is unknown but is thought to suppress the
inflammatory response by neutralizing histamines

Signs and Symptoms

(due to altered respiratory function because of increased airway
resistance):

Wheezing (due to obstruction to airflow in the bronchioles and smaller

bronchi) on expiration (expiration is prolonged because of the difficulty
of breathing out air thru a narrowed airway)
Dyspnea; nose flaring; cyanosis; restlessness; fatigue; increased heart
and respiratory rates
Secretions are thicker and more tenacious, especially in an anxious child
Excessive perspiration; dilated neck veins
Acid-base Imbalance (respiratory acidosis) due to impaired
respirations and increased formation of carbonic acid
Increased Eosinophils count exact role is unknown but is thought to
suppress the inflammatory response by neutralizing histamines

Incidence: Uncommon in infancy; incidence increases after 3 years of age

Between 100 and 150 million people

around the globe--roughly the equivalent
of the population of the Russian
Federation -- suffer from asthma and this
number is rising. World-wide, deaths from
this condition have reached over 180,000
annually.

Around 8% of the Swiss population suffers

from asthma as against only 2% some 2530 years ago.

In Germany, there are an estimated 4

million asthmatics.

In Western Europe as a whole, asthma has

doubled in ten years, according to the
UCB Institute of Allergy in Belgium.

In the United States, the number of

asthmatics has leapt by over 60% since
the early 1980s and deaths have doubled
to 5,000 a year.

There are about 3 million asthmatics in

Japan of whom 7% have severe and 30%
have moderate asthma.

Asthma is not just a public health

problem for developed countries. In
India hascountries,
an estimated
15-20the
million
developing
however,
asthmatics.
incidence
of the disease varies greatly.
In the Western Pacific Region of
WHO, the incidence varies from over
50% among children in the Caroline
Islands to virtually zero in Papua
New Guinea.

In Brazil, Costa Rica, Panama, Peru

and Uruguay, prevalence of asthma
symptoms in children varies from
20% to 30%.

In Kenya, it approaches 20%.

In India, rough estimates indicate a
prevalence of between 10% and 15%
in 5-11 year old children.
Source: World Health
Organization

Medical Records Section

Statistical Report
January to December 2010 - 2015
CAUSES OF DISCHARGE
180
160
140
120
100
80
60
40
20
0

166

164

130
112
79

94
71

71
53

2010

111

2011

2012
Male

2013

54

2014

52

2015

Female

Source: Lung Center of the

Diagnosis
A diagnosis of asthma should be suspected if there is
a history of: recurrent wheezing, coughing or
difficulty breathing and these symptoms occur or
worsen due to exercise, viral infections, allergens or
air pollution.
Spirometryis then used to confirm the diagnosis. In
children under the age of six the diagnosis is more
difficult as they are too young for spirometry.

Spirometryis a common office test used to assess how well

your lungs work by measuring how much air you inhale,
how much you exhale and how quickly you
exhale.Spirometryis used to diagnose asthma, chronic
obstructive pulmonary disease (COPD) and other conditions
that affect breathing.

Supportive Management

Oxygen of low concentration

Adequate hydration
High fowlers position
Frequent small meals
Vaporized water inhalations

Drug Management
Bronchodilatorsare recommended for short-term relief of
symptoms. In those with occasional attacks, no other medication is
needed.
Short-actingbeta2-adrenoceptor agonists (SABA), such as
salbutamol are the first line treatment for asthma symptoms.They
are recommended before exercise in those with exercise induced
symptoms
Antichollinergic medications. such asipratropium bromide provide
additional benefit when used in combination with SABA in those with
moderate or severe symptoms

Longterm control
Corticosteroids : considered the most effective treatment available for longterm control. Inhaled forms such asbeclomethasone are usually used except in
the case of severe persistent disease. (It is usually recommended that inhaled
formulations be used once or twice daily, depending on the severity of
symptoms)
Long-acting beta-adrenoceptor agonists(LABA)
Delivery methods
Metered-dose Inhalers (MDIs) in combination with an asthma spacer or as
adry powder inhaler. The spacer is a plastic cylinder that mixes the medication
with air, making it easier to receive a full dose of the drug.
Nebulizer may also be used. Nebulizers and spacers are equally effective in
those with mild to moderate symptoms. However, insufficient evidence is
available to determine whether a difference exists in those with severe disease.

Common Bronchodilator Drugs

in the Philippines :
Asmalin P 1.95
Broncaire P 2.85
Librentin P 2.90
Ventar P 3.19
Ventolin P 3.72
Asmalin P 42.75
Salbutamol Sterinebs P 17.60
Glaxo Wellcome
Ventolin Respirator 5mg/ml
Solution P 180.00
Ventolin 500mcg/ml Injection P
62.00
Terbutaline 2.5 mg tablet (as
sulfate) Fil-Adams Bronchodam
Tab P 2.53
Terbulin P 4.85

Common Metered Dose

Inhalers (MDI) :
Asmacaire100 mcg/actuation MDI
P 215.00
Librentin 100 mcg/Actuation MDI
P 218.35
Asmalin 100 mcg/Actuation MDI P
229.30
Novartis Rev-Air P 258.00
Ventolin 100mcg Inhaler non-CFC
P 280.00

Date/
Shift

Time

03/20/2016 7:30
7 3 pm am
8:00
8:15
8: 30
9: 30

Focus

Data, Action, Response

Airway

D> "Nahihirapan akong huminga"

> Wheezing sound upon auscultation
> RR = 10
A > Elevate head of the bed and change position
every 2 hour
> Keep environment allergen (smoke, dust
particles) free
> Seen and examined by Dr. Lee and assisted with
bronchoscopy
R> "Maluwag na ang aking paghinga"
>Breath sounds clear and respiration noiseless
>RR = 16
>Participates in treatment regimen
>Demonstrate behaviors to maintain airway
clearance
RN Signature

Date/
Shift

Time

03/30/2016 4:30
3 11 pm
4:35
5:30
5:45
6:10

Focus

Data, Action, Response

Mucuos
Production

D> "Dumadami ang plema ko"

>Changes in rate and depth of respiration
>RR=12
A >Placed patient in bed on semi-fowler postion
>Monitored the chest wall retraction
> Encouraged deep- breathing and coughing
exercise
D> "Hindi ko malabas un plema ko"
A > Maintained semi-fowler position
>Suctioned the patient via oral
R> "Pakiramdam ko wala ng plema sa lalamunan
ko"
>Breath sounds clear and respiration
> Advised patient to drink warm water
RN Signature

Discharge Instructions

Seek care immediately if:

severe shortness of breath

lips or nails turn blue or gray
skin around the neck and ribs pulls in with each breath
shortness of breath, even after short-term medicine has been taken as directed.

Manage symptoms and prevent future attacks:

Follow the Asthma Action Plan (AAP).This is a written plan that the patient and
the healthcare provider create. It explains which medicine is needed and when to
change doses if necessary. It also explains how to monitor symptoms and use a peak
flow meter. The meter measures how well lungs are working.

Manage other health conditions, such as allergies, acid reflux, and sleep apnea.
Identify and avoid triggers.These may include pets, dust mites, mold, and
cockroaches.

Do not smoke or be around others who smoke.Nicotine and other chemicals in

cigarettes and cigars can cause lung damage.

Ask about the flu vaccine.The flu can make an asthma worse. May need a yearly
flu shot.