Ma. Rosario A.

Angeles
WHAT IS ASTHMA?

 Diffuse, obstructive lung disease with (1)

hyperreactivity of the airways to a variety of stimuli
and (2) a high degree of reversibility of the
obstructive process, w/c may occur either
spontaneously or as a result of treatment.
 Also known as “Reactive Airway Disease, (RAD)”
 PATHOPHYSIOLOGY

Manifestations of airway obstruction are due to:

 Bronchoconstriction
 Hypersecretion of mucus
 Mucosal edema
 Cellular infiltration
 Desquamation of epithelial and inflammatory
cells
Mast cells in Asthma Pathogenesis:
 Components of an
Asthma Attack
Early Immune Response
Bronchoconstriction
the consequence of immunoglobulin E–dependent
mediator release upon exposure to aeroallergens and is the
primary component of the early asthmatic response

normal Asthma attack

Components of an
Asthma Attack
Late phase reaction
Mucosal edema
occurs 6-24 hours following an allergen challenge and is referred
to as the late asthmatic response.
Excessive Secretions
Chronic mucous plug formation consists of an
exudate of serum proteins and cell debris that may take
weeks to resolve.
Airway remodeling
associated with structural changes due to long-
standing inflammation and may profoundly affect the extent
of reversibility of airway obstruction.
Components of an Asthma
Attack
- Edema and Bronchospasmreduction of
lumen size with resulting increase of work of
breathing and decrease in airflow.
- Mismatching of ventilation w/perfusion,
alveolar hypoventilation & Inc work
breathing changes in blood gases
Components of an Asthma
Attack
 Hyperventilationcompensates initially for higher CO2
tension in the blood that perfuses poorly ventilated
region, but it cannot compensate for hypoxemia
because of patient’s inability to inc. partial pressure of
O2 and oxyhemoglobin saturation further alveolar
hypoventilation and hypercapnia occurs
 Hypoxia interferes w/conversion of lactic acid to CO2
and H20  met acidosis
 Hypercapnia increases carbonic acid w/c dissociates
into hydrogen and bicarbonate ions respi acidosis
SIGNS AND SYMPTOMS OF AN
ASTHMA ATTACK
 Cough
 Wheezing
 Tachypnea
 Dyspnea with prolonged expiration
 Use of accesory muscle of respiration
 Cyanosis
 tachycardia
 Diagnosis
- Recurrent episodes of coughing and
wheezing especially if trigerred by exercise, viral
infection or inhalled allergens are highly suggestive
of asthma
- Pulmonary function testing before and after
administration of methacholine or a bronchodilator
or before and after exercise may help establish the
diagnosis of asthma
Causes:

 Factors that can contribute to asthma or airway hyperreactivity may

include any of the following:
 Environmental allergens
 Viral respiratory infections
 Exercise; hyperventilation
 Gastroesophageal reflux disease
 Chronic sinusitis or rhinitis
 Aspirin or nonsteroidal anti-inflammatory drug hypersensitivity, sulfite sensitivity
 Use of beta-adrenergic receptor blockers (including ophthalmic preparations)
 Environmental pollutants, tobacco smoke
 Occupational exposure
 Emotional factors
 Irritants such as household sprays and paint fumes
Lab Studies:
Laboratory studies are not routinely indicated for asthma but may
be used to exclude other diagnoses.
 Blood Eosinophilia greater than 250-400 cells/mm3 is usual.
 Allergy skin testing: useful adjunct in individuals with atopy
 Chest radiography: findings are normal or indicate
hyperinflation.

.
Procedures:
 Pulmonary function testing (spirometry)
 Perform spirometry measurements before and after inhalation of a
short-acting bronchodilator in all patients in whom the diagnosis of
asthma is considered. Spirometry measures the forced vital capacity,
the maximal amount of air expired from the point of maximal inhalation,
and the FEV1. A reduced ratio of FEV1 to forced vital capacity, when
compared with predicted values, demonstrates the presence of airway
obstruction. Reversibility is demonstrated by an increase of 12% or 200
mL after administration of a short-acting bronchodilator.
 The diagnosis of asthma cannot be based on spirometry findings alone
because many other diseases are associated with obstructive
spirometry indices.
Methacholine- or histamine-
challenge testing
 Bronchoprovocation testing with either
methacholine or histamine is useful when
spirometry findings are normal or near normal
 CLASSIFICATION OF ASTHMA SEVERITY

Severity Prior to Initiation of Therapy

Mild Intermittent Mild Persistent Moderate Severe Persistent

Persistent
Symptoms < or = 2 per week > 2 per week daily symptoms continual symptoms

Nighttime < or = 2 per month > 2 per month > 1 per week frequent
symptoms

Lung function < or = 80% < or = 80% > 60% - < or = 60%
predicted predicted < or = 80%

Peak flow variability < 20% 20-30% > 30% > 30%
 STEP THERAPY BASED ON ASTHMA SEVERITY
Classification Quick Relief Long-Term Control

Step 1: Mild Intermittent prn None.

Step 2: Mild Persistent prn Single agent with anti-inflammatory activity.

Step 3: Moderate prn Inhaled corticosteroids, add long-acting bronchodilator if
Persistent needed.
Step 4: Severe Persistent prn Multiple long-term control medications. Add oral
corticosteroids if needed.

LONG TERM CONTROL Rx QUICK-RELIEF MEDICATIONS

Corticosteroids*** Short-acting beta-agonists*
Cromolyn/nedocromil** Anti-cholinergics*
Leukotriene modifiers** Systemic glucocorticosteroids***
Methylxanthines**
Long-acting beta-agonists*
 PREVENTION:
KNOW THE ASTHMA ATTACK
Pets
TRIGGERS!
Indoor pollution

Weather

Pollens
Exercise
 How to Use the
Student’s Health Care Plan
Read the health care plan
developed by the school nurse
Know your student’s asthma
attack triggers
Be familiar with emergency
action plans
Contact school nurse with
questions