DISEASE SPECIFIC INFORMATION DISEASE/DEFINITION Asthma- chronic inflammatory airway disease characterized by intermittent airway obstruction and hypersensitivity.

PATHOPHYSIOLOGY- inflammation and airway hyper-responsiveness (AHR). The large and the small airways with diameters <2 micrometers are the sites of inflammation and airway obstruction. Airway inflammation occurs secondary to a complex interaction of inflammatory cells, mediators, and other cells and tissues in the airway. An initial trigger leads to the release of inflammatory mediators, which leads to the consequent activation and migration of other inflammatory cells. The inflammatory reaction is a T-helper type 2 (Th2) lymphocytic response. Th2 inflammation is characterized by the presence of CD4+ lymphocytes that secrete interleukin (IL)-4, IL-5, and IL-13, the chemokine eotaxin, TNFalpha, and the leukotriene LTB4, a product of the lipoxygenase pathway, as well as mast cell tryptase. This Th2 response is important in the initiation and prolongation of the inflammatory cascade. CLINICAL MANIFESTATIONS (SIGNS AND SYMPTOMS) - wheezing - dyspnea - cough - breathlessness - chest tightness COMPLICATIONS Severe asthma exacerbations when pt. is dyspneic at rest and the pt. speaks in words, not sentences, because of difficulty breathing.

COMMON TREATMENT Drug Therapy: Antiinflammatory drugs: corticosteroids, leukotriene modifiers (e.g., montelukast [Singulair]), Anti-IgE (omalizumab [Xolair]) Bronchodilators: B2-adrenergic agonists, Methylxanthines (e.g., Theophylline [Uniphyl]), anticholinergics (inhaled) (e.g., tiotropium [Spiriva]) DIAGNOSTICS- History and physical examination - Pulmonary function studies including response to bronchodilator therapy - Peak expiratory flow rate (PEFR) - Chest x-ray - Measurement of oximetry - Allergy skin testing - Blood level of eosinophils and IgE (if indicated) TEACHING NEEDS Do not shake your medicine. - Tilt your head back slightly and breathe out, getting as much air out of your lungs as you can. Do not breathe into your inhaler. - Close your lips tightly around the mouthpiece of the inhaler. - Hold your breath for 10 seconds or as long as you can to disperse the medicine into your lungs. - Do not keep your DPI in a humid place such as a shower room because the medicine can clump. COMMON NURSING INTERVENTIONS Monitor rate, rhythm, depth, and effort of respiration to determine need of intervention - Auscultate breath sounds, noting symmetry, use of accessory muscles, and supraclavicular and intercostals muscle retractions. - Administer medications as ordered to improve respiratory function. - Coach in breathing/relaxation techniques to improve respiratory rhythm and rate. - Offer warm fluids to drink to liquefy secretions and promote bronchodilation. REFERENCE: PAGE NUMBER FOR LEWIS. FULL TITLE, AUTHOR, AND PAGE NUMBER FOR OTHER SOURCES Medical-Surgical Lewis Pages 587 609