This document provides information about asthma including its definition, incidence, triggers, pathophysiology, classification, clinical manifestations, complications, diagnostic evaluation, medical management including pharmacologic therapy, and nursing assessment and interventions. It defines asthma as a chronic inflammatory airway disease characterized by recurrent exacerbations of coughing, wheezing and shortness of breath. It notes that asthma affects over 25 million Indians and discusses common asthma triggers. The medical management section covers different classes of medications used to treat asthma including bronchodilators, anti-inflammatories, leukotriene modifiers and combinations. Nursing care involves assessing symptoms and lung sounds, monitoring for signs of anxiety or distress, educating patients about asthma self-management, and teaching techniques
2. Definition
Asthma is a chronic inflammatory disease of the airways
characterized by hyper-responsiveness, mucosal edema,
and mucus production.
This inflammation ultimately leads to recurrent episodes of
asthma symptoms: cough, chest tightness, wheezing, and
dyspnea.
3. Definition
Patients with asthma may experience symptom-free
periods alternating with acute exacerbations that last
from minutes to hours or days.
Asthma, the most common chronic disease of
childhood, can begin at any age.
4. Incidence
Asthma affects an estimated 25,000,000 indians every
year and this number is likely to increase by 50 % by the
year 2016.
COPDs and asthma accounts for nearly 1.5 % of total
disease burden in the country.
Among adults, women have a 30 % greater prevalence of
asthma than men.
5. TIGGERS OF ACUTE ASTHMA ATTACKS
Allergen inhalation
Animal danders (e.g cats , mice)
House dust mite
Pollens
Air pollutants
Exhaust fumes
Perfumes
Cigrarette smoke
Areosol sprays
Viral upper respiratory infection
Sinusitis
Exercise and cold , dry air
Stress
Drugs
Aspirin
Non steroidal anti inlammatory drugs
occupational exposure
metal salts
industrial chemical and plastics
pharmaceutical agents
food additives
hormones/menses
gastroesophageal relux disease
7. classification symptoms
Step 1
Mild intermittent
Symptoms ≤2 times/wk
Asymptomatic and normal PEFR between
exacerbations
Exacerbations brief (hours to days)
Intensity of excerbations varies
Step 2
Mild persistent
Symptoms >2 times/wk but <1 times /day
Exacerbations may affect activity
Step 3
Moderate persistent
Daily symptoms
Daily use of inhaled short acting β2 -
agonist
Exacerbations affect activity
Exacerbations at least 2 times/wk and may
last for days
Step 4
Severly persistent
Continual symptoms
Limited physical activity
Frequent exacerbations.
9. Clinical Manifestations
cough (with or without mucus production),
wheezing (first on expiration, then possibly during
inspiration as well).
Asthma attacks frequently occur at night or in the
early morning.
An asthma exacerbation is frequently preceded by
increasing symptoms over days, but it may begin
abruptly.
Chest tightness and dyspnea.
Expiration requires effort and becomes prolonged.
As exacerbation progresses, central cyanosis secondary
to severe hypoxia may occur.
Additional symptoms, such as diaphoresis, tachycardia,
and a widened pulse pressure, may occur.
12. Collaborative Care : Diagnostic
History and physical examination
Pulmonary function studies including response to
bronchodilators therapy
Peak expiratory flow rate
Chest X-rays
Measurement of ABGs or oximetry (if severe exacerbation)
Allergy skin testing (if indicated)
Nitric oxide levels
13. Collaborative therapy
Mild intermittent or persistent asthma
Identification and avoidance /elimination of triggers
Desensitization (immunotherapy) if indicated
Patient and family teaching
Drug therapy
Asthma action plan
14. Collaborative therapy
STATUS ASTHMATICUS
Sao2 monitoring
ABG’s
Inhaled β2 - adrenergic agonists or anticholinergic agents
O2 by mask or nasal prongs
IV or oral corticosteriods
IV fluids
IV magnesium
Intubation and assisted ventilation
25. TREATMENT FOR ASTHMA
LONG-TERM CONTROL
MEDICATIONS
Anti-inflammatory medications
Inhaled or oral glucocorticoids
Cromolyn (Intal); nedocromil (Tilade)
Leukotriene modifiers
Omalizumab (Xolair)
Oral and inhaled bronchodilators
Theophylline
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29. NURSING ASSESSMENT
Subjective data
Important health information
Past health history :allergic ,sinusitis , or skin allergies;
previous asthma attacks and hospitalization or intubation ;
symptoms worsened by pollen, dander , feathers, mold, dust,
inhaled irritants, weather changes, exercise, smoke, menses;
gastrophageal reflux; occupational exposure to chemical
irritants (e.g. paints, dust)
Medications: use of and compliance with corticosteroids,
bronchodilators, cromolyn, antibiotics; pattern and amount of
short acting β-adrenergic agonist used per week; medications
that may precipitate an attack in susceptible asthmatics such
as aspirin, non steroidal anti-inflammatory drugs, β-
30. NURSING ASSESSMENT
Subjective data
Functional health patterns
Health perception–health management: family history of
allergies or asthma; recent upper respiratory infection or
sinus infection
Activity exercise: fatigue decreased or absent exercise
tolerance ;dyspnea, cough(especially at night), productive
cough with yellow or green sputum or sticky sputum ; chest
tightness , feeling of suffocation , air hunger , talk in
sentences or words/phrases , sitting upright in order to
breathe
Sleep-rest: awakened from sleep because of cough or
breathing difficulties, insomnia
Coping-stress tolerance: emotional distress, stress in work
31. NURSING ASSESSMENT
OBJECTIVE DATA
General
Restlessness or exhaustion, confusion, upright or forward-leaning
body position
Integumentary
Diaphoresis, cyanosis (circumoral, nail bed), eczema
Respiratory
Nasal discharge, nasal polyps, mucosal swelling; wheezing, crackles ,
diminished or absent breath sounds, and rhonchi on auscultation ;
hyperresonance on percussion ; sputum (thick, white, tenacious), ↑
work of breathing with the use of accessory muscles; intercostal and
supraclavicular retractions; tachypnea with hyperventilation;
prolonged expiration
Cardiovascular
Tachycardia, pulsus paradoxus, jugular venous distention,
32. NURSING ASSESSMENT
OBJECTIVE DATA
Possible findings
Abnormal ABC’s during attacks, ↓ O2 saturation,
serum and sputum eosinophilia, ↑ serum Ig E ,
positive skin tests for allergens, chest X-ray
demonstrating hyperinflation with attacks, abnormal
pulmonary function tests showing ↓ flow rates;
FVC, FEV1 , PEFR , and FEV1 /FVC ratio that
improve between attacks and with bronchodilators.
33. NURSING DIAGNOSIS
Ineffective airways clearance related to
bronchospasm, excessive mucus production,
tenacious secretions and fatigue as evidenced by
ineffective cough, inability to raise secretions,
adventitious breath sounds.
34. NURSING DIAGNOSIS
INTERVENTIONS AND RATIONALES
Asthma management
Determine baseline respiratory status to use as a comparison
point.
Monitor rate, rhythm, depth, and effort of respiration to determine
need for intervention and evaluate effectiveness of interventions.
Observe chest movement, including symmetry, use of accessory
muscles and supraclavicular and intercostals muscle retractions to
evaluate respiratory status.
Auscultate breath sounds, noting areas of decreased /absent
ventilation and adventitious sounds, to evaluate respiratory status.
Administer medication as appropriate and/ or per policy and
procedural guidelines to improve respiratory function.
Coach in breathing /relaxation technique to improve respiratory
rhythm and rate.
Offer warm fluids to drink to liquefy secretions and promote
bronchodialtion.
35. NURSING DIAGNOSIS
Anxiety related to difficulty breathing , perceived or
actual loss of control and fear of suffocation as
evidenced by restlessness, elevated pulse ,
respiratory rate and blood pressure.
36. NURSING DIAGNOSIS
INTERVENTION AND RATIONALES
ANXIETY REDUCTION
Identify when level of anxiety changes to determine
possible precipitating factors.
Use calm, reassuring approach to provide reassurance.
Stay with patient to promote safety and reduce fear.
Encourage verbalization of feelings, perceptions and
fear to identify problem areas so appropriate planning
can take place.
Instruct patient in the use of pursed lip breathing and
relaxation techniques to relieve tension and to promote
ease of respirations.
37. NURSING DIAGNOSIS
Deficient knowledge related to lack of information
and education about asthma and its treatment as
evidenced by frequent questioning regarding all
aspects of long term management.
38. NURSING DIAGNOSIS
INTERVENTIONS AND RATIONALES
Asthma management
Determine patient/family understanding of disease and
management to assess learning needs.
Teach patient to identify and avoids triggers as possible to prevent
asthma attacks.
Encourage verbalization of feelings about diagnosis, treatment
and impact on lifestyle to offer support and increase compliance
with treatment. Educate patient about the use of the peak
expiratory flow rate (PEFR) meter at home to promote self
management of symptoms.
Instruct patient/family on anti inflammatory and bronchodilator
medications and their appropriate use to promote understanding
of effects.
Teach proper technique for using, medication and equipment
(e.g. inhaler, nebulizer, peak flow meter) to promote self care.
Establish a written plan with the patient for managing
exacerbations to plan adequate treatment of future exacerbations.