Asthma
- 1. ASTHMA SUDESHNA BANERJEE DUTTA ASSISTANT PROFESSOR S.R.S.V.M B.SC NURSING COLLEGE
- 4. INTRODUCTION ❖ Asthma is a lower respiratory tract disease; it is an pulmonary obstructive disease. ❖It is also called as “REACTIVE AIRWAY DISEASE”
- 6. DEFINITION ❖Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm.
- 7. ETIOLOGY AND RISK FACTOR Asthma occurs in families which suggest that it is an inherited disorder Allergy is the strongest predisposing factor for asthma Chronic exposure to airway irritants or allergens also increases the risk for developing asthma Common allergens can be seasonal (eg, grass, tree, and weed pollens, mold, dust, or animal dander)
- 8. ETIOLOGY AND RISK FACTOR Excitatory state (stress ,cry ) Occupational environment Other factor such as cold air ,air pollution, infection, diet
- 9. ETIOLOGY AND RISK FACTOR Triggers Allergens Upper respiratory tract viral infections Exercise Cold air Sulfur dioxide Drugs ( BETA blockers, aspirin) Stress Irritants (household sprays, paint fumes)
- 10. CLASSIFICATION Asthma is a complex disorder of the conducting airways that most simply can be classified as: • Extrinsic – implying a definite external cause • Intrinsic – when no causative agent can be identified
- 12. PATHOPHYSIOLOGY Exposure to allergens & irritants IGE stimulation Mast cells degranulation Histamine Prostaglandins Bradikinins Leukotrienes Air way hyper-responsiveness Mucus secretion Inflammation Bronchospasm Non productive cough Shortness of breath Wheezing, chest tightness, Peak flow variability
- 13. CLINICAL MANIFESTATIONS The principal symptoms of asthma are wheezing attacks and episodic shortness of breath Typical symptoms include recurrent episodes of wheezing, chest tightness, breathlessness and cough In some instances, cough may be the only symptom Cough, with or without mucus production Expiration requires effort and becomes prolonged.
- 14. CLINICAL MANIFESTATIONS As the exacerbation progresses, diaphoresis, Tachycardia and a widened pulse pressure may occur along with hypoxemia and central cyanosis
- 15. CLINICAL MANIFESTATIONS • Wheezing • Cough • Chest tightness • Dyspnea • Hypoxia • Nasal flaring • Sputum is thick and tenacious • Decreased or absence of breath sounds called “SILENT CHEST”
- 16. DIAGNOSTIC STUDIES History taking: A complete family, environmental, and occupational history is essential Family history : History of asthma in family Environmental history : seasonal changes, high pollen counts, mold, climate changes (particularly cold air), and air pollution Occupational history : occupation-related chemicals and compounds, including metal salts, wood and vegetable dust
- 17. DIAGNOSTIC STUDIES Industrial chemicals and plastics, biologic enzymes (e.g. laundry detergents), animal and insect dusts, sera, and secretions Physical examination ▪ Wheezing all over the lung ▪ Breathlessness and cough ▪ Cyanosis
- 18. DIAGNOSTIC STUDIES Lung function tests/ pulmonary function test : Shows variable airflow limitation Blood tests :shows increase in the number of eosinophils in peripheral blood (> 0.4 × 109/L) Sputum tests The presence of large numbers of eosinophils in the sputum is a more useful diagnostic tool
- 19. DIAGNOSTIC STUDIES Chest X-ray : There are no diagnostic features of asthma on the chest X-ray A chest X-ray may be helpful in excluding a pneumothorax, which can occur as a complication of asthma Skin tests Skin-prick tests (SPT) should be performed in all cases of asthma to help identify allergic causes.
- 22. MANAGEMENT Reassure the patient , as anxiety worsen respiratory distress Keep the patient in upright position Start oxygen 50-60 % initially, continue till the patient is better and not dyspnoeic Nebulize with salbutamol or Terbutalin for immediate relief. Salbutamol 5 mg (1 ml with 1 ml normal saline) stat. Repeat dose at 15 mins if required during the first hour. Hourly for next few hours till bronchospasm is controlled.
- 25. MANAGEMENT Secure I/V line ✓Inj. Hydrocotisone 200mg I/V stat routinely given to all severe cases then 6 hourly ✓Antibiotic if there is evidence of infection ✓Adequate hydration and mucolytics.
- 26. MANAGEMENT Medications • Bronchodilators: -LONG ACTING BETA ADRENERGIC BLOCKERS: e.g.: SALMETEROL, FORMETEROL,THEOPHYLLINE • Anti-inflammatory drugs: -CORTICOSTERIODS: e.g.: FLUNISOLIDES, BECLAMETHASONE, CROMOLYN • Mast cell stabilizers: e.g.: MONTELUKAST, ZILEUTON • DRY POWDER INHALERS
- 27. MANAGEMENT Magnesium sulfate intravenous treatment has been shown to provide a bronchodilating effect when used in addition to other treatment in severe acute asthma attacks Heliox, a mixture of helium and oxygen, may also be considered in severe unresponsive cases
- 28. NURSING MANAGEMENT Check vital signs at regular intervals Monitor allergic symptoms Administer medication, note action of medications Avoid exposure to pollution environment Deep breathing exercises Health education.
- 29. NURSING DIAGNOSIS • Ineffective airway clearance related to increased production of secretions and bronchospasm • Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction, and airway irritants • Activity intolerance due to fatigue, ineffective breathing patterns, and hypoxemia • Deficient knowledge of self-care strategies to be performed at home • Ineffective coping related to reduced socialization, anxiety, depression, lower activity level, and the inability to work
- 30. PREVENTIVE MEASURES FOR ASTHMA Use of face mask Avoid upper respiratory tract infection as much as possible Avoid smoking and smoky environment Avoid passive smoking Cover bedding with "allergy-proof" casings to reduce exposure to dust mites Remove carpets from bedrooms and vacuum regularly Use only odorless detergents and cleaning materials in the home Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold
- 31. PREVENTIVE MEASURES Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help a child with asthma. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes as much as possible.