asthma

1. ASTHMA

2. What happens in asthma?

3. INTRODUCTION
 Asthma is a chronic
disease involving the
respiratory system in
which the airway
constricts, become
inflamed and are lined
with an excessive amount
of mucus, often in
response to one or more
trigger.

4. Definition
 Asthma is a disorder of the bronchial airways
characterized by periods of bronchospasm
(spasms of prolonged contraction of airway).
Or
 Asthma is a reactive airway disorder
characterized by inflammation and episodic
airway obstruction resulting from
bronchospasm , increased mucus secretions
and mucosal edema.

5. Globally asthma causes 1,80,00 deaths
annually.
IN U.S.A.
Incidence –2-3%
Death rate –1 per 100,00 persons.
In 50% of patients – disease begins
before 10 years of age.
In 30 % - occurs before age of 40.
During childhood 2:1 Male/Female
prevalence.

6. EPIDEMIOLOGY
About 150,00 hospital
admissions in a year.
5 millions of work lost each
year.
IN INDIA :
In India, WHO estimated 15
to 20 millions asthmatic
patients.
0.6% in rural population.
3.2% in urban women.
4% in urban males.

7. CAUSES OF ASTHMA
GENE-
ENVIRONMENTAL
THEORY
OTHER THEORIES

8. GENE – ENVIRONMENT THEORY
GENE ENVIRON -
MENT
NOT YET FULLY UNDERSTOOD

9. ENVIRONMENTAL TOBACCO SMOKE
POOR AIR QUALITY AND HIGH OZONE
LEVEL
PSYCHOLOHICAL STRESS
ANTIBIOTICS
INFECTION
SOCIO-ECONOMIC FACTORS
METHOD OF DELIVERY
ASTHMA AND ATHLETES
OCCUPATIONAL FACTORS
INFECTION

10. ENVIRONMENTAL TOBACCO
SMOKE
 It is one of the major
factor contributing to
asthma.
 Maternal cigarette
smoking, especially, is
associated with high risk
of asthma prevalence and
asthma morbidity.

11. POOR AIR QUALITY AND
HIGH OZONE LEVELS
These has been repeatedly associated with
increased asthma morbidity

12. PSYCHOLOGICAL STRESS
 It has long been
suspected of being an
asthma trigger.
 It is thought that stress
modulates the immune
system to increase the
magnitude of the airway
inflammatory response to
allergens and irritants.

13. ANTIBIOTICS
 It has been suggested that antibiotics
used early in life has been linked to
the development of asthma.
Another drug,
Acetaminophen ,
connected with the
rise in prevalence
of asthma.

14. Upper respiratory infections like cold flu, sinusitis
during childhood can lead to asthma.

15. SOCIO-ECONOMIC FACTORS
 The incidence of asthma is highest among in
over crowded areas and where there is
presence of cockroches in living quarters.

16. METHOD OF DELIVERY
 Caesarean section have been
associated with asthma when
compared with vaginal birth, a
meta-analysis found a 20%
increase in asthma prevalence
in children delivered by
caesarean as compared to
those who were not.
 It is due to modified bacterial
exposure during caesarean
section compared with vaginal
birth which modifies the
immune system as described by
the hygiene hypothesis.

17. ASTHMA AND ATHLETICS
 Athletes with mild asthma
may be more likely to be
diagnosed with the condition
 In addition, there exists a
variant of asthma called
Exercise-induced asthma
that shares many features
with allergic asthma.

18. OCCUPATIONAL ASTHMA
 American Thoracic Society (2004)
suggest that 15%-23% of new onset
asthma cases in adults are work
related.
 In one study monitoring workplace asthma
by occupation,
 operators
 fabricators
 laborers(32.9%),
 managerial
 professional specialists (20.2%),
 technical, sales, and
 administrative support jobs (19.2%).
 Most cases are associated with the
manufacturing (41.4%) and services
(34.2%) industries.

19. STIMULANTS OR ALLERGIC
TRIGGER

20. 1. ALLERGENS
 House dust mite
 Cockroach
 Grass pollen
 Mold pores

21. 2. VOLATILE ORGANIC
COMPOUNDS
Perfumes and perfumes products-
 Soap
 Laundry detergent
 Paper tissues
 Paper towel
 Shampoo
 Hair spray
 Cosmetics
 Candles etc.

22. 3. FOOD ALLERGIES
 Milk
 Peanuts
 Eggs & Fishes
 Sulphites

23. 4. ALLERGENIC AIR
POLLUTION
 Ozone
 Nitrogen dioxide
 Sulfur dioxide

24. 5. EARLY CHILDHOOD
INFECTONS
 Viral upper
respiratory tract
infections (sinusitis,
rhinitis etc)

25. 6. OTHERS
 Exercise in
dry & cold weather
 Hormonal changes

26. Causes
Extrinsic (atopic)
 Begins in childhood
 Sensitive to specific
external allergens
Causes:
 Pollen (type 1
hypersenstivity reaction)
 Animal dander
 Dust/mold
 Feather pillow
 Noxious fumes
Intrinsic (non atopic)
 Trigerred by internal
disorders
 Non allergic
Causes
 Irritants
 Emotional stress, anxiety
 Fatigue
 Endocrine changes
 Coughing or laughing
 Genetic factors

27. Types of asthma
CHARACTERI-
STICS
EXTRINSIC
ASTHMA
INTRINSIC
ASTHMA
1. Age at onset
2. Cause or
Precipitating factors
3. Genetic influence
3-35 years
Agents such as dust,
pollen, insects, smoke n
food, change in temp,
strong odours, stress,
emotions etc
Positive
Under 3, over 35 or 40
years
No evidence of
external allergens,
triggered by internal
disorders like common
cold or URTI or even
exercise, worse in
winters
Variable

28. CHARACTERI-
STICS
EXTRINSIC
ASTHMA
INTRINSIC
ASTHMA
4. Sputum
5. Skin test
6. Serum IgE
7. Typical attack
Clear & foamy, contain
eosinophils.
Positive & correlating
High or normal
Acute & self-limiting
Thick, white or
discoloured, contain
eosinophils, other
leucocytes, bacteria
Negative
Normal
Often fulminant &
severe

29. CHARACTERI-
STICS
EXTRINSIC
ASTHMA
INTRINSIC
ASTHMA
8. Response to
therapy
9. Intractable
asthma
10. Death
Good response to
immuno-
therapy &
bronchodilators
Uncommon
Rare
Poor response to
bronchodilators, no
response to
immunotherapy.
Common
Most frequent

30. PATHOPHYSIOLOGY
EXTRINSIC ASTHMA
Exposure to allergens and irritants
Stress, exercise, cold air & other etiological factors
Stimulation of B lymphocytes
Production of IgE by lymphoid tissue
IgE antibodies attach to mast cells and basophils
in bronchial walls
Ag-Ab reaction at the surface of mast cells and basophils
Mast cell degranulation(effect on permeability of cell wall)

31. Release of chemical mediators
(Histamine, Prostaglandins, Bradykinin, SRS-A)
Inflammation Bronchospasm Inc. mucus increased
secretion vascular
Shortness of permeability
breath Plugging
of airway Airway
edema
Increased volume
& pressure
Hyperventilation

32. Release of chemical mediators
(Histamine, Prostaglandins, Bradykinin, SRS-A)
Histamine leukotrienes prostaglandins
(SRS-A)
Attach to
receptor sites
in large
bronchi
Swelling of
smooth
muscle
Narrows
lumen
Attach to
receptor sites
in large bronchi
Swelling of
smooth muscle
Narrows lumen
Enhances
histamine
function

33. INTRINSIC ASTHMA
Precipitating factors
Parasympathetic Sympathetic
nervous system nervous
system
Release of
acetylcholine Stimulate
Alpha adrenergic
receptors
Bronchoconstiction in bronchi
- Stimulation of mucus
glands
-Vasodilation
Bronchoconstriction

34. CLINICAL MANIFESTATIONS
Cough, dyspnoea and wheezing.
 Starts suddenly with coughing
and tight sensation in the chest
followed by slow laborious
breathing.
 Expiration is always strenous &
prolonged.
 Low oxygen saturation
 Nasal flaring as respiratory
distress increases
 Pursed lip breathing with use of
accessory muscles
 Coma
 Cyanosis (late)

35. Other associated symptoms are:
 Some patients are panic,
scarred and worried.
 Dizziness, tingling sensation,
headache, numbness.
 Finally they complain of:
-no energy
-weak
-worn out and fatigued

36. DIAGNOSTIC EVALUATION

37. DIAGNOSTIC EVALUATION
HISTORY LAB TEST OTHERS
family
Environ-
mental
Occupa-
tional
Blood
test
skin test
PFT
Spirometry
ECG
ABG
X ray

38. Asthma
Treatment and prevention

39. PrEVENTION
(A) A person can prevent an attack of
asthma by avoiding known allergens or
triggers
(B) Current treatment protocols
recommend prevention medications such
as an inhaled corticosteroid

40. PrEVENTION
Asthmatics sometimes stop taking their preventive
medication when they feel fine which results in further
attacks and no long improvements.
Preventive agents include the following ;
 Inhaled Glucocorticoid (Beclomethasone )
 Mast cell stabilizers (Cromoglicate)
 Anticholinergics (Ipratropium)
 Methlyxanthines (Theophylline)

41. Prevention
(C) Other trigger avoidance
 PHYSICAL ACTIVITY
 Take one or 2 puffs from an albuterol inhaler 15 -30
minutes before beginning exercise
 Warm up gradually at the beginning of each exercise
session.
 Take all medications on schedule.
 Avoid exercising outdoors in extremely cold
weather and cover the mouth and nose with a
scarf to help warm the inspired air.

42. Prevention
 If asthma symptoms occur during exercise, stop
immediately and rest.
 If your breathing difficulty continues, use "quick
relief" inhaled bronchodilator.
 Occupational hazards
 Limit exposure in a workplace
 If possible, people whose asthma is triggered by
strong odors should avoid the use of chlorine and
bleach-based cleaning products.

43. Prevention
 CIGARETTE SMOKE AND ASHES
A person with asthma should never smoke and second-
hand smoke should be avoided whenever possible.
 AEROSOL SPRAYS, PERFUMES
Non-aerosol products should be used, and exposure to
offending perfumes avoided.
 GAS STOVES, FIREPLACE SMOKE AND COOKING
ODORS
Wood-burning stoves, fireplaces, and pellet stoves
and unvented gas stoves or heaters can worsen asthma
symptoms. Cooking areas should be well ventilated.

44. Prevention
 AIR POLLUTION, CAR EXHAUST, GAS FUMES
Patients should avoid unnecessary exposure to car
exhaust, and outdoor exercise should be avoided
when pollution levels are high.
 FORMALDEHYDE AND VOLATILE ORGANIC
COMPOUNDS
Odors from new linoleum flooring, carpeting,
particleboard, wall coverings, furniture, and recent
painting can worsen asthma symptoms in some people.

45. EMERGENCY
TREATMENT
First
aid
In
Emergency
Deptt.

46. emergency treatment
1.First Aid (The 4 x 4 x 4 technique)
• Sit the person comfortably upright.
• Be calm and reassuring. Try not to leave them
alone.
• Give 4 puffs of a reliever inhaler (puffer) –
Ventolin, asmol etc. (best given through a spacer)
• Use 1 puff at a time and ask the person to take
4 breaths from the spacer after each puff

48. emergency treatment
 If oxygen is available, it should be administered
at 6-8 litres per minute through a face-mask.
 Wait 4 minutes. If there is no improvement,
give another 4 puffs
 If little or no improvement, CALL AN
AMBULANCE IMMEDIATELY.
 Keep giving 4 puffs every 4 minutes until the
ambulance arrives or the patient improves
significantly.

49. emergency treatment
2.In Emergency Department
 Oxygen to alleviate the hypoxia (but not
the asthma itself) that results from
extreme asthma attacks. (5-8 l/min)
 Nebulized salbutamol or terbutaline (short-
acting beta-2-agonists), often combined
with ipratropium (an anticholinergic).

50. emergency treatment
 Others
• Systemic steroids, oral or intravenous
(prednisolone, dexamethasone, or hydrocortisone)
• Anticholinergics, IV or nebulized, with systemic
effects (glycopyrrolate, atropine, ipratropium)
• Methylxanthines (theophylline, etophylline)

51. emergency treatment
• Heliox, a mixture of helium and oxygen, may be
used in a hospital setting. It has a more laminar
flow and moves more easily through constricted
airways.
 Intubation and mechanical ventilation, for patients
in or approaching respiratory arrest.

52. is there a cure For asthma?
 Asthma cannot be cured, but it
can be controlled. You should
expect nothing less.

53. PrinciPLes oF treatment
 To prevent acute attack of asthma
 To treat the acute attack of asthma
 To minimise the asthmatic attacks
 To control asthma on long term basis
 To help the patient to lead a healthy
normal life.

54. Preventive or controL
meDication

55. Name of
drug
Dose/route description Adverse
effects
Nursing consideration
inhaLeD
cortico
steroiD
s-
AeroBid;
(flunisoli
de)
Amatory
(triamcin
olone)
Becloven
t;
(beclome
thasone)
Flovent(
fluticaso
ne)
Pulmicor
250mcg/i
nhalation
100mcg/in
halation
40-80
mcg twice
daily
88-440
mcg twice
daily
-They are slow-
acting (They take
hours or weeks
before they
become effective)
-They do not
provide immediate
relief of symptoms
-Regular use
decrease the need
for your reliever
medication .
-Dose should be
decreased to
lowest amount
required to control
symptoms.
Hoarsenes
s
Cough
Thrush
(yeast
infection in
the mouth)
Headache
Dysphonia
-Monitor PFT, respiratory
status and lung sounds.
- Assess patients for signs
of adrenal insufficiency
- Monitor for urine and
serum glucose
concentration
-Advice patient to take
medicine as directed. Take
missed dose as soon as
remembered
-Advice patient not to use
inhalation corticosteroid in
acute attack.
-ask the patient to notify
if sore throat has occurred
-Gargling and rinsing the

56. metereD Dose inhaLer
 MDI is a device that helps deliver a
specific amount of drug to the lungs ,
usually by supplying a short burst of
aerosolized medicine that is inhaled by the
patient.
 Consists of two components - canister
- actuator
 Use of spacer or holding chamber reduces
the chances of oral complications

57. contD.
Instruct the patient the proper use of MDI
3 methods-
First method-
 Shake inhaler well
 Take a drink of water to moisten the throat
 Place the inhaler mouth piece 2 finger widths
away from mouth
 Tilt the head back slightly
 While activating inhaler, take a slow 1 deep
breath for 3-5 sec , hold the breath for 10 sec
and breath out slowly

58. contD.
Second method-
 Exhale
 Close lips firmly around mouth piece
 Administer during second half of inhalation
 Hold the breath for as long as possibleto ensure
deep instillation of medicine
Third method-
 Use a spacer
-Allow 1-2 min between inhalations
-Rinse the mouth with water or mouthwash
after each use to minimise fungal infection

59. Non Pharmacological
Treatment

60. ASTHMATIC PERSONALITY
It is characterized by:
Anxiety
Insecurity
Over dependency
Lack of self-confidence
Anger is submissive.
Asthmatic children are more maladjusted and
emotionally unstable.
There are chances of occurrence of
psychoneurosis and behavioral problems in
children and adults with asthma.

61. CONTROLLING ANGER- BEFORE
IT CONTROLS YOU
ANGER
Anger is "an emotional state that varies in
intensity from mild irritation to intense fury
and rage," according to Charles Spielberger,
PhD, a psychologist who specializes in the study
of anger.

62. ANGER MANAGEMENT
 The goal of anger management is to reduce both
your emotional feelings and the physiological arousal
that anger causes.
 There are some strategies to keep anger at bay.
These are:
1. Relaxation
2. Cognitive restructuring
3. Problem solving
4. Better communication
5. Using humor
6. Changing your environment

63. Yoga & relaxation
techniques
 These may be helpful for managing and
controlling asthma

64. NURSING MANAGEMENT
ASSESSMENT:
During the initial assessment,
the nurse should carefully assess
for any pattern to the asthmatic
episodes. This may lead to the
identification of specific precipitating
factors.
Assess for any family history of asthma
or patient history of allergy which are then avoided.
Constant monitoring of patient by nurse is important for the
first 24hrs.

65. NURSING MANAGEMENT
Check the skin turgor for signs of dehydration.
Continuous monitoring of of vital signs.
Non-allergic pillows are to be used.
During mechanical ventilation the patients cardiac function
and ABG’s are to be carefully monitored.

66. NURSING DIAGNOSIS:
1. Ineffective airway clearance r/t increases production of
secretions.
2. Ineffective breathing pattern r/t impaired exhalation
and anxiety.
3. Anxiety r/t acute breathing difficulties and fear of
suffocation.
4. Activity intolerance r/t inadequate oxygenation and
dyspnoea.
5. Ineffective coping r/t repressed anxiety and
exacerbation of physical symptoms.

67. Ineffective airway clearance r/t increases production of
secretions.
Nursing Interventions Rationale
-Suction out the secretions.
- Encourage oral fluids.
(6-8 glass)
- Give frequent oral care 2-4
hourly.
-Provide postural drainage, lung
percussion, vibration, chest
physiotherapy.
-Teach and supervise incentive
spirometry 5times per hour.
-To clear the tracheo-bronchial
tract.
-To thin the secretions and to
replace fluid loss through rapid
respiration.
- Clean and re-moisten the oral
mucous membranes.
- If chest secretions are thick
and difficult to expectorate.
- It will promote lung
expansion.

68. Ineffective breathing pattern r/t impaired exhalation and
anxiety.
Nursing Interventions Rationale
-Assess the clients breathing
pattern for shortness of
breath,nasal flaring,prolonged
expiration.
-Place the client in fowler’s
post.
-Administer humidified O2.
-Monitor ABG’s and O2
saturation level.
-Provide medications to the
patient as prescribed.
-To check the severity of
disease.
-Increases lung capacity.
-It will help in thinning
the secretions.
-To Determine the
effectiveness of treatment.
-To improve the
condition.

69. Anxiety r/t acute breathing difficulties and fear of
suffocation.
Nursing Interventions Rationale
-Remain with client during acute
episodes of breathing difficulties.
-Provide calm and quiet envn.
-Limit the no. of people &
unnecessary equipments in the
room.
-Encourage the use of relaxation
techniques.
-Give sedatives and tranquilizers
if needed with caution.
-Reassures the client
that help is available.
-It promote relaxation.
-Environmental changes
lessen suffocation.
-Reduce anxiety.
-Overdose can cause
respiratory depression.

70. Activity intolerance r/t inadequate 02 and dyspnoea.
Nursing Interventions Rationale
-Monitor the severity of dyspnea
and O2 saturation with and
following activity.
-Maintain supplemental oxygen.
-Schedule active exercise after
medication (bronchodilators in
meter dose inhalers)
-Activity increases the
demand for oxygen and
cause dyspnoea and
desaturation.
-It helps in alleviating
exercise induced
hypoxemia.
-Lung function is
maximised during peak
periods of treatment.

71. Contd………..
Nursing Interventions Rationale
-Advice the client to avoid
conditions that increase 02
demand such as smoking,
stress, temp. extremes.
-Instruct the client for energy
conservation technique, such
as adequate rest periods
between activities.
-Teach the client about pursed
lip and diaphragmatic
breathing.
-These cause vasoconstriction
increases cardiac work load
and oxygen requirement.
-Conservation techniques
allow the client to accomplish
more tasks with limited
energy supply.
-It leaves positive end-
expiratory pressure in lungs
and keep the airways open.