Asthma

by AJAGIDI O. JOY
B.S. NURSING
 Asthma
Definition

 Reactive airway disease

 Chronic inflammatory lung disease
Inflammation causes varying degrees of
obstruction in the airways
 Asthma is reversible in early stages
 Triggers of Asthma

 Allergens
 Exercise
 Respiratory Infections
 Nose and Sinus problems
 Drugs and Food Additives
 GERD
 Emotional Stress
 Asthma
Pathophysiology

 Bronchospasm
 Airway inflammation
 Asthma
Pathophysiology

Early-Phase Response
 Peaks 30-60 minutes post exposure, subsides 30-

90 minutes later
 Characterized primarily by bronchospasm

 Increased mucous secretion, edema formation,

and increased amounts of tenacious sputum

 Patient experiences wheezing, cough, chest

tightness, and dyspnea

 Asthma
Pathophysiology
Late-Phase Response
 Characterized primarily by inflammation
 Histamine and other mediators set up a self-
sustaining cycle increasing airway reactivity
causing hyperresponsiveness to allergens and
other stimuli
 Increased airway resistance leads to air trapping
in alveoli and hyperinflation of the lungs
 If airway inflammation is not treated or does not
resolve, may lead to irreversible lung damage
Factors Causing Airway Obstruction in
Asthma

Fig. 28-3
 Summary of Pathophysiologic
Features

 Reduction in airway diameter

 Increase in airway resistance r/t
 Mucosal inflammation
 Constriction of smooth muscle
 Excess mucus production
 case study

 38-Year-Old Female With No Previous Histo

ry of Asthma
 Patient presentation and history
 38-year-old female referred for possible im
munodeficiency
 Patient presented with a worsening shortne
ss of breath, chest tightness, and coughing,
especially in the previous 2 weeks
 Described itchy, watery eyes, congestion, an
d drainage when around cats and also in th
e spring, summer, and fall
 Past medical history and medications
 Frequent infections of bronchitis, sinusitis,
and strep throat over the previous 6 month
s
 Previous pulmonary function tests were rep
ortedly normal
 No previous known history of allergy or ast
 No past or current medications for her cond
ition
 Initial assessments
 A fractional exhaled nitric oxide (FeNO) me
asurement was performed and found to be
52 ppb
 Pulmonary function tests and chest x-ray w
ere both normal
 Allergy test results positive to cats, dogs, tre
es, grasses, and weeds
 Allergy test results positive to cats, dogs, tre
es, grasses, and weeds
 Initial therapy
 Treated for asthma aggressively with oral st
eroids for 5 days
 Started a combination inhaled corticosteroi
d and long-acting beta agonist
 Asthma
Clinical Manifestations

 Unpredictable and variable

 Recurrent episodes of wheezing,

breathlessness, cough, and tight chest
 Asthma
Clinical Manifestations

 Expiration may be prolonged from a

inspiration-expiration ratio of 1:2 to 1:3 or
1:4

 Between attacks may be asymptomatic

with normal or near-normal lung function
 Asthma
Clinical Manifestations

Difficulty with air movement can create a

feeling of suffocation
 Patient may feel increasingly anxious
 Mobilizing secretions may become difficult
 Asthma
Clinical Manifestations
Examination of the patient during an acute
attack usually reveals signs of hypoxemia
 Restlessness
 Increased anxiety
 Inappropriate behavior
 Increased pulse and blood pressure
 Pulsus paradoxus (drop in systolic BP during
inspiratory cycle >10)
 Asthma
Complications
Status asthmaticus
 Severe, life-threatening attack refractory

to usual treatment where patient poses

risk for respiratory failure
 Asthma
Diagnostic Studies

 Detailed history and physical exam To rule

out other possible conditions — such as a
respiratory infection or chronic obstructive
pulmonary disease (COPD) — the doctor will
do a physical exam and ask questions about
signs and symptoms and about any other
health problems.
 Peak flow monitoring A peak flow meter is
a simple device that measures how hard you
can breathe out. Lower than usual peak flow
readings are a sign your lungs may not be
working as well and that your asthma may be
getting worse. Your doctor will give you
instructions on how to track and deal with
low peak flow readings.
•Spirometry. This test estimates the narrowing of your
bronchial tubes by checking how much air you can
exhale after a deep breath and how fast you can breathe
out.
•Allergy testing. This can be performed by a skin test or blood
test. Allergy tests can identify allergy to pets, dust, mold and
pollen. If important allergy triggers are identified, this can lead
to a recommendation for allergen immunotherapy.
 Sputum eosinophils. This test looks for
certain white blood cells (eosinophils) in the
mixture of saliva and mucus (sputum) you
discharge during coughing. Eosinophils are
present when symptoms develop and become
visible when stained with a rose-colored dye
(eosin).
 Asthma
Diagnostic Studies

• Pulmonary function tests

• Chest x-ray
• ABGs
 Oximetry
 Sputum culture and sensitivity
 Asthma
Drug Therapy

 Long-term control medications

 Achieve and maintain control of persistent
asthma
 Quick-relief medications
 Treat symptoms of exacerbations
 Asthma
Drug Therapy

 Bronchodilators
 -adrenergic agonists
(e.g., albuterol, salbutamol[Ventolin])
 Acts in minutes, lasts 4 to 8 hours

 Short-term relief of bronchoconstriction

 Treatment of choice in acute exacerbations

 Asthma
Drug Therapy

 Bronchodilators
 Useful in preventing bronchospasm
precipitated by exercise and other stimuli
 Overuse may cause rebound bronchospasm

 Too frequent use indicates poor asthma

control and may mask severity
 Asthma
Drug Therapy
 Bronchodilators (longer acting)
8 – 12 or 24 hr; useful for nocturnal asthma
 Avoid contact with tongue to decrease side
effects
 Can be used in combination therapy with
inhaled corticosteroid
 Asthma
Drug Therapy

Antiinflammatory drugs
 Corticosteroids (e.g., beclomethasone,
budesonide)
 Suppress inflammatory response

 Inhaled form is used in long-term control

 Systemic form to control exacerbations and

manage persistent asthma
 Asthma
Drug Therapy
Antiinflammatory drugs
 Corticosteroids

 Do not block immediate response to

allergens, irritants, or exercise
 Do block late-phase response to subsequent
bronchial hyperresponsiveness
 Inhibit release of mediators from
macrophages and eosinophils
 Asthma
Drug Therapy
Anti-inflammatory drugs
 Mast cell stabilizers (e.g., cromolyn, nedocromil)
 Inhibit release of histamine

 Inhibit late-phase response

 Long-term administration can prevent and reduce

bronchial hyper-reactivity
 Effective in exercise-induced asthma when used 10
to 20 minutes before exercise
 Asthma
Drug Therapy

 Leukotriene modifiers (e.g. Singulair)

 Leukotriene – potent bronchco-constrictors
and may cause airway edema and
inflammation
 Have broncho-dilator and anti-inflammatory
effects
 Asthma
Patient Teaching Related to Drug
Therapy
Correct administration of drugs is a major
factor in determining success in asthma
management
 Some persons may have difficulty using an MDI
and therefore should use a spacer or nebulizer
 DPI (dry powder inhaler) requires less manual
dexterity and coordination
 Asthma
Patient Teaching Related to Drug
Therapy

 Inhalers should be cleaned by removing dust

cap and rinsing with warm water
 -adrenergic agonists should be taken first if
taking in conjunction with corticosteroids
 Nursing Management
Nursing Diagnoses

 Ineffective airway clearance

 Anxiety

 Ineffective therapeutic regimen

management