NORSHAHIDAH BINTI ZAINAL

SD2017-04-002565
 DEFINITION

• Asthma is a CHRONIC INFLAMMATORY disorder of the

airways that causes recurrent episodes of
wheezing,breathlessness,chest tightness and coughing.
 PATHOPHYSIOLOGY

• Airway wall swelling (mucosal edema)

• Airway hyper responsiveness

• Chronic changes

• Hypertrophy of the smooth muscles, thickening of the

basement membrane

• Airway remodeling

• There is good evidence that asthma occurs in families.

 SIGN AND SYMPTOM
 Shortness of breath

 Chest tightness or pain

 Trouble sleeping caused by shortness of breath, coughing or

wheezing

 A whistling or wheezing sound when exhaling (wheezing is a

common sign of asthma in children)

 Coughing or wheezing attacks that are worsened by a

respiratory virus, such as a cold or the flu
 CAUSES

• Domestic dust mites

• Air pollution

• Tobacco smoke

• Occupational irritants

• Cockroach

• Animal with fur

• Pollen
 DIAGNOSTIC
1. Spirometry: A lung function test to measure breathing capacity and how
well you breathe. You will breathe into a device called a spirometer.

2. Peak Expiratory Flow (PEF): Using a device called a peak flow meter,
you forcefully exhale into the tube to measure the force of air you can
expend out of your lungs. Peak flow monitoring can allow you to monitor
how well your asthma is doing at home.

3. Chest X-ray: Your doctor may do a chest X-ray to rule out any other
diseases that may be causing similar symptoms.
 COMPLICATION

• fatigue

• underperformance or absence from work

• psychological problems including stress, anxiety and

depression.

• pneumonia (infection of the lungs)

• a collapse of part or all of the lung

• respiratory failure

• Dead
 CASE SCENARIO

• Khalid 14 years old come to the clinic c/o

shortness of breath for one day duration.
• He is a known asthmatic patient for more
than 8 years, he visited A/E frequently.
• His school performance is below average,
with frequent absence from school due to
his illness.
 PATIENT PARTICULAR
1.MEDICAL RECORD:
2.NAME:
3.GENDER:FEMALE
4.AGE:40 YEARS OLD BIL OBSERVATION RESULTS
5.ETHNIC:MALAY
01 Pain score 3/10
6.OCCUPATION:HOUSEWIFE
7.WEIGHT:58.9KG 02 Temperature 36.8 ˚C
8.DIAGNOSIS: 03 Respiration rate 20/minutes
04 Blood pressure 120/74mmHg
05 Pulse rate 95 bpm
06 Pulse rhythm Normal
07 Pulse volume Good
08 Body weight 65kg
09 GCS 15/15
CHIEF COMPLAINT

• Short of breath × 1/7 days

HISTORY OF PRESENT ILLNESS

Patient complain of short of breathes since today

 Coughing with yellowish sputum since today

 No fever
 No flu
 No vomiting
 No diarrhoea
 No tacypnea

in casualty

 6.35am
 Patient still alert but breath fast and still claiming short of breath but the
saturation still 99 % under room temperature
 Found that there are rhonchi sound occur on both lung occur during
auscultation
 PATIENT HISTORY

 Patient never been admitted to the ward since she was

diagnosed as bronchial asthma since she was young

 She was on inhaler salbutamol 2 puff tds/prn

 patient not smoking

 patient not drink alcohol

 no other bronchial asthma found occur among her other

siblings
 PHYSICAL EXAMINATION
Head to Toe(oral,throat,ear,eye and nasal):  BREAST:Nipple is normal,no lump
 ORAL:Normally distributed
teeth,absense of halitosis,tougue is
coated
 THROAT:No swelling or inflammation
 EAR:Ears are symmentrical,absence of
discharge,hearing is normal
 EYE:Vision is normal,sclera and
conjunctiva normal
 NASAL:No discharge present
 LOWER LIMB:No edema

LUNG  No scar over the abdomen

 Fundus heigth 25cm
 No abnormalities noted
 MANAGEMENT
At emergency and trauma department

 Continue give patient A:V:N (1:2:3) stat

 Let patient rest in bed completely
 Monitor the vital sign
 Give oxygen when needed
Doctor plan
 Continue NEB A:V:N
 Iv Hydrocortisone Sodium 250mg STAT
 MDI Salbutamol 2 puff tds/prn
 Tab Prednisolone 30mg od
 Syrup Dephendhydramine HCl 15ml tds
 Tab Bromhexine HCl 8mg tds
 Tab Paracetamol 1gm tds/prn
 TCA prn
 Allowed discharge when the condition good
 HEALTH EDUCATION
 Get enough rest to speed up the healing goal.

 Destroy crowded and dusty places to prevent secondary infection.

 Use mask if forced to be in a crowded and dusty area so that the respiratory tract
does not get irritated.

 Perform your own breathing exercises to restore breathing as well as promote the
flow of oxygen throughout the body.

 Eat high food with vitamin C to enhance body immunity.

 Clean the home area from dust to avoid the occurrence of shortness of breath.

 Take medication according to the dosage and time set by the doctor.

 Eliminate alcohol and cigarette intake to prevent irritation in the lungs.

 Apply a healthy lifestyle with a balanced diet and exercise to enhance body
immunity.
SUMMARY
 REFERENCES
• https://www.mayoclinic.org/diseases-
conditions/asthma/symptoms-causes/syc-
20369653
• https://www.healthdirect.gov.au/complicati
ons-of-asthma