Bronchial Asthma

CASE ANALYSIS
Definition
A condition of the lungs characterized by widespread narrowing of the
airways due to spasm of the smooth muscle, edema of the mucosa, and the
presence of mucus in the lumen of the bronchi and bronchioles. Bronchial asthma is
a chronic relapsing inflammatory disorder with increased responsiveness of
tracheobroncheal tree to various stimuli, resulting in paroxysmal contraction of
bronchial airways which changes in severity over short periods of time, either
spontaneously or under treatment.

Pathophysiology
Exposure to allergens
Inflammation

Increase constriction of the

Smooth muscle

Hypersecretion of mucus in the bronchial tree to mucosal edema

Dyspnea

Causes
Allergy is the strongest predisposing factor for asthma. Chronic exposure to
airway irritants or allergens can be seasonal such as grass, tree and weed pollens or
perennial under this are the molds, dust and roaches. Common triggers of asthma
symptoms and exacerbations include air way irritants like air pollutant, cold, heat,
weather changes, strong odors and perfumes. Other contributing factor would
include exercise, stress or emotional upset, sinusitis with post nasal drip ,
medications and viral respiratory tract infections.

Most people who have asthma are sensitive to a variety of triggers. A

person’s asthma changes depending on the environment activities, management
practices and other factor.
Clinical Manifestation
The three most common symptoms of asthma are cough, dyspnea, and
wheezing. In some instances cough may be the only symptoms. An asthma attack
often occurs at night or early in the morning, possibly because circadian variations
that influence airway receptors thresholds.

An asthma exacerbation may begin abruptly but most frequently is preceded by

increasing symptoms over the previous few days. There is cough, with or without
mucus production. At times the mucus is so tightly wedged in the narrow airway
that the patient cannot cough it up.

Prevention
Patient with recurrent asthma should undergo test to identify the substance
that participate the symptoms. Patients are instructed to avoid the causative agents
whenever possible. Knowledge is the key to quality asthma care.

Medical Management
There are two general process of asthma medication: quick relief medication
for immediate treatment of asthma symptoms and exacerbations and long acting
medication to achieve and maintain control and persistent asthma. Because of
underlying pathology of asthma is inflammation, control of persistent asthma is
accomplish primarily with the regular use of anti inflammatory medications.

• Long-acting control Medication

Corticosteroid are the most potent and effective anti inflammatory currently
available. They are broadly effective in alleviating symptoms, improving air way
functions, and decreasing peak flow variability. Cromolyn sodium and nedocromil
are mild to be moderate anti-inflammatory agents that are use more commonly in
children. They also are effective on a prophylactic basis to prevent exercise-induced
asthma or unavoidable exposure to known triggers. These medications are
contraindicated in acute asthma exacerbation.

`Long acting beta-adrenergic agonist is use with anti-inflammatory medications to

control asthma symptoms, particularly those that occur during the night these
agents are also effective in the prevention of exercise-induced asthma.

• Quick relief medication

Short acting beta adrenergic agonists are the medications of choice for relief of
acute symptoms and prevention of exercise-induced asthma. They have the rapid
onset of acton. Anti-cholinergic may have an added benefit in severe exacerbations
of asthma but they are use more frequently in COPD.
Nursing Management

The main focus of nursing management is to actively assess the air way and the
patient response to treatment. The immediate nursing care of patient with asthma
depends on the severity of the symptoms. A calm approach is an important aspect
of care especially for anxious client and one’s family.

• This requires a partnership between the patient and the health care providers
to determine the desire outcome and to formulate a plan which include;
• the purpose and action of each medication
• trigger to avoid and how to do so
• when to seek assistance
• the nature of asthma as chronic inflammatory disease

URDANETA CITY UNIVERSITY

San Vicente West,
West, Urdaneta City
CASE ANALYSIS
-BRONCHIAL ASTHMA-

Submitted by;
Fernandez, Rosalyn

Submitted to;
Mrs. Marcela Zamora

November
2009