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ASTHMA

 
DEFINITION:- 
Asthma is a chronic inflammatory disease of airway caused by allergic response of bronchi resulting in reversible narrowing of airway due to bronchoconstriction (spasm), congestion and thickening of walls of bronchi and accumulation of mucous. (Recurrent attacking of Dyspnoea and wheezing). CAUSES/AETIOLOGY:- 
They are some factors whic are responsible for Asthma:
1. Enviromental factors:
  • Change in temperature mostly cold air.
  • Change in humidity (dry air).
2. Atmospheric pollutants:
  • Cigarette, industrial smoke, ozone, sulphurdioxide, formaldehyde.
3. Allergen inhalation:
  • Food treated with sulphate, beer, wine etc.
4. Stress/emotional upset
5. Medication:

  • NSAIDs, Beta-Blockers.
6. Strong odours and perfumes
RISK FACTORS:-
  • Family history
  • History of allergen
  • Passive smoking
  • Obesity
  • Urban living
  • Low birth Weight
  • Regular use of NSaIDs.
TYPES OF ASTHMA:-
It is of two types:
  1. Extrinsic (Allergic): Commonly occur in childhood.
  2. Intrinsic (Non-allergic): Commonly occur about 35 years of age.
CLINICAL MANIFESTATION (SIGNS/SYMPTOMS):-
  • Wheezing
  • Cough (All night and early in morning)
  • Chest tightness
  • Dyspnoea
  • Prolong expiration
  • Hypoxemia
  • Ronchi (Sound during inspiration)
  • Attack of asthma may be for few minutes/hours.
PATHOPHYSIOLOGY:-
According to types
1. Extrinsic (Allergic)
 1. Allergic /Antigen   2. IgE Antibody
                                    ↓ 
1. Mast Cells  2. Basophills
                                    ↓ 
Chemical Mediator Release
  • Histamine
  • Prostaglandins
  • Cytokinine
  • Leukotrines
                          ↓ 
Bronchoconstriction
                         ↓ 
Dyspnoea 
2. Intrinsic (Non-allergic): It begins with both parasympathetic and sympathetic response.
parasympathetic Nervous system
                        ↓ 
Release of Acetylcholine
                        ↓ 
Bronchoconstriction
                        ↓ 
sympathetic Nervous System
                        ↓ 
Stimulation of alpha-adrenegic receptors
                        ↓ 
Bronchoconstriction 
DIAGNOSTIC EVALUATION:-
  • Physical examination
  • History collection
  • Spirometry
  • ABG (Atrial blood gas analysis)-Hypoxemia, Increased (Pco2) acidosis.
  • Chest X-ray (for hyperinflation of lungs).
  • Auscultation of breath sound (Wheezing sound).
COMPLICATIONS:-
  • Respiratory failure
  • Pneumonia
  • Cardiac arrest
  • Status Asthmaticus
  • Atelectasis.
MEDICAL MANAGEMENT:-
1. Bronchodilator (Beta-agonist): They causes widening of the airway by relaxing bronchial smooth muscle by stimulate beta-receptors.
Example
  • Salbutamol
  • Formoterol
  • Albuterol
2. Xanthine derivatives:
Example
  • Theophylline
  • Deriphylline
  • Aminophylline
3. Anticholinergic: The actions of these drugs include relaxation of smooth muscle, and decreased secretion of mucus (antispasmodic action).
Example
  • Ipratropium
  • Atropine sulphate (Nebulizer
4. Corticosteroids: Anti-inflammatory and antiallergic
Example
  • Methylprednisolone
  • Prednisolone
  • Betamethasone
5. Leukotriene receptor antagonist: They prevent the action of Leukotriene by blocking their receptors on cell membranes (Leukotrines have a key role in inflammation).
Example
  • Montelukast
  • Zafirlukast
6. Mast cell stabilizers: They stop the activities of mast cells.
Example
  • Cromolyn sodium.
NURSING MANAGEMENT:-
Assessment
  • Assess clinical signs of airway distress of patient.
  • If it is acute airway distress we should give emergency management.
  • Take a history of patients.
  • Collect Knowledge about allergic reaction in different enviromental condition.
  • Ask about working place.
  • Allergic modifications.
  • Life style.
Nursing diagnosis with implementation
1. Ineffective breathing pattern related to anxiety or due to airway spasm or oedema.
Nursing Intervention
  • Assess respiratory rate and breath pattern and depth.
  • Monitor ABG.
  • To give fowler position to patient.
  • Aministration of oxygen as prescription.
  • Provide Bronchodilator and steroids.
2. Detective airway clearance related to increase secretion production and bronchospasm.
Nursing Intervention
  • Suctioning may be given if airway obstruct.
  • Monitor sputum for colour and consistency.
  • To encourage for liquid diet for thin secretion (sputum).
  • Increase humidity of room slowly.
  • To give oral hygiene in every 2-4 hours.
3. Knowledge deficit due to disease condition.
Nursing Intervention
  • Provide Knowledge about disease to the patient.
  • Provide psychological support to the patient.
  • Advice the patient to be far away from the items from which he/she is having allergy.
  • Give comfortable position.
4. Chest pain related to disease condition
Nursing Intervention
  • Provide analgesics.
  • use of bronchodilators.
  • Oxygen inhalation.
5. Maintain nutritional status
Nursing Intervention
  • High intake of vitamins and protein diet for increases immunity.
  • Enccourage for balanced diet.
6. Reduce infection
Nursing Intervention
  • Safe disposal of sputum or secretion.
  • Provide antibiotics.
Health Education:-
  • Avoid allergens.
  • Avoid extreme cold weather.
  • Avoid mouth breathing.
  • Avoid contact with infectious person.
  • Avoid smoking (active/passive).


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