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ASTH MA

FAMADOR O. GENALDO, MD, RN

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 DEFINITION

 is a disease of the respiratory system in


which the airways constrict, become
inflamed, and are lined with excessive
amounts of mucus, often in response to
one or more "triggers," such as exposure
to an environmental stimulant (or allergen
), cold air, exercise, or emotional stress.

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 CHARACTERISTICS

 The disorder is a chronic or recurring


inflammatory condition in which the
airways develop increased responsiveness
to various stimuli, characterized by
bronchial hyper-responsiveness,
inflammation, increased mucus
production, and intermittent airway
obstruction

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 Etiology

 It is not clear exactly what makes the


airways of people with asthma
inflamed.
 New research suggests that being
exposed to things like tobacco
smoke, infections, and some
allergens early in your life may
increase your chances of developing
asthma.
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 There are things in the environment
that bring on your asthma symptoms
and lead to asthma attacks.
 Some of the more common things
include exercise, allergens, irritants,
and viral infections.
 Some people have asthma only when
they exercise or have a viral
infection.

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There are seven categories of stimuli:

 allergens, typically inhaled, which include


waste from common household insects,
such as the house dust mite and
cockroach, grass pollen, mould spores and
pet epithelial cells;

 medications, including aspirin and


β-adrenergic antagonists (beta blockers);

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 air pollution, such as ozone,
nitrogen dioxide, and sulfur dioxide,
which is thought to be one of the major
reasons for the high prevalence of
asthma in urban areas;

 various industrial compounds and other


chemicals, notably sulfites; chlorinated
swimming pools generate chloramines—
monochloramine (NH2Cl), dichloramine
(NHCl2) and trichloramine (NCl3)—in the
air around them, which are known to
induce asthma.

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 early childhood infections, especially viral
respiratory infections. However, persons of
any age can have asthma triggered by
colds and other respiratory infections even
though their normal stimuli might be from
another category (e.g. pollen) and absent
at the time of infection.

 exercise, the effects of which differ


somewhat from those of the other triggers

 emotional stress, which is poorly


understood as a trigger
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Pathophysiology
 The mechanisms behind allergic asthma—
i.e., asthma resulting from an
immune response to inhaled allergens—are
the best understood of the causal factors.
 In both asthmatics and non-asthmatics,
inhaled allergens that find their way to the
inner airways are ingested by a type of cell
known as antigen presenting cells, or APCs.

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 APCs then "present" pieces of the allergen
to other immune system cells. In most
people, these other immune cells (
TH0 cells) "check" and usually ignore the
allergen molecules. In asthmatics,
however, these cells transform into a
different type of cell (TH2), for reasons
that are not well understood.
 The resultant TH2 cells activate an
important arm of the immune system,
known as the humoral immune system.
The humoral immune system produces
antibodies against the inhaled allergen.

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 Later, when an asthmatic inhales the same
allergen, these antibodies "recognize" it
and activate a humoral response.
Inflammation results: chemicals are
produced that cause the airways to
constrict and release more mucus, and the
cell-mediated arm of the immune system
is activated.

 The inflammatory response is responsible


for the clinical manifestations of an
asthma attack.
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 In essence, asthma is the result of an
abnormal immune response in the
bronchial airways.

 The airways of asthmatics are "


hypersensitive" to certain triggers, also
known as stimuli.

 In response to exposure to these triggers,


the bronchi (large airways) contract into
spasm (an "asthma attack").

 Inflammation soon follows, leading to a


further narrowing of the airways and
excessive
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mucus production, which leads 12
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Signs and Symptoms
 Coughing.
 Coughing from asthma is often worse at
night or early in the morning, making it
hard to sleep.

 Wheezing.
 Wheezing is a whistling or squeaky
sound when you breathe.

 Chest tightness.
 This can feel like something is squeezing
or sitting on your chest.
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 Shortness of breath.
 Some people say they can't catch their

breath, or they feel breathless or out of


breath.
 You may feel like you can't get enough

air in or out of your lungs.

 Faster breathing or noisy breathing.

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Medical Management
 Symptomatic control of episodes of
wheezing and shortness of breath is
generally achieved with fast-acting
bronchodilators. These are typically
provided in pocket-sized, metered-dose
inhalers (MDIs).

 Nebulizer—which provides a larger,


continuous dose—can also be used.
Nebulizers work by vaporizing a dose of
medication in a saline solution into a
steady
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stream of foggy vapour, which the 16
Medications

 Short-acting, selective
beta2-adrenoceptor agonists, such as salbutamol
(albuterol USAN), levalbuterol, terbutaline and
bitolterol - inhaled delivery, which allows the drug
to target the lungs specifically;caution against
using these medicines too frequently, efficacy
may decline, producing desensitization resulting
in an exacerbation of symptoms which may lead
to refractory asthma and death.

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 Older, less selective adrenergic agonists,
such as inhaled epinephrine and ephedrine
tablets - inhaled epinephrine has been
shown to be an effective agent to
terminate an acute asthmatic
exacerbation

 Anticholinergic medications, such as


ipratropium bromide - can be used in
patients with heart disease; however, they
take up to an hour to achieve their full
effect and are not as powerful as the β2-
adrenoreceptor agonists
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Nursing Management
 The most effective treatment for asthma is
identifying triggers, such as pets or
aspirin, and limiting or eliminating
exposure to them.

 Desensitization to allergens has been


shown to be a treatment option for certain
patients.

 Smoking cessation and avoidance of


secondhand smoke is strongly encouraged
in asthmatics.
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 For those in whom exercise can trigger an
asthma attack (exercise-induced asthma),
higher levels of ventilation and cold, dry
air tend to exacerbate attacks.

 For this reason, activities in which a


patient breathes large amounts of cold air,
such as skiing and running, tend to be
worse for asthmatics, whereas swimming
in an indoor, heated pool, with warm,
humid air, is less likely to provoke a
response

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 Monitoring your asthma so that you can
recognize when your symptoms are
getting worse and respond quickly to
prevent or stop an asthma attack.

 Avoiding things that bring on your asthma


symptoms or make your symptoms worse.
Doing so can reduce the amount of
medicine you need to control your asthma.

 Advise to carry quick-relief inhaler with


you at all times in case of an asthma
attack.
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