Asthma

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Mr. ANILKUMAR B R
Lecturer
MS.c Nursing
Medical –Surgical nursingBronchial asthma

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OBJECTIVES
 Define Bronchial Asthma and status
asthmatics.
 Enlist triggers of bronchial Asthma
 Discuss the clinical manifestations
 Describe assessment, diagnostic findings,
complications, prevention, medical and
nursing management of patients with asthma
and status asthmatics

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Introduction
Asthma can occur at any age and is the
most common chronic disease of
childhood. Despite increased knowledge
regarding the pathology of asthma and the
development of better medications and
management plans, the death rate from
asthma continues to increase.

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 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 (e.g., grass, tree, and weed
pollens) or perennial (e.g., mold, dust,
roaches, or animal dander).

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Bronchial asthma
 Asthma is a chronic inflammatory disease of
the airways that causes airway hyper
responsiveness, mucosal edema, and mucus
production. This inflammation ultimately leads
to recurrent episodes of asthma symptoms:
cough, chest tightness, wheezing, and
dyspnea

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Definition of Bronchial asthma
 Bronchial asthma is a chronic ,
inflammatory disease of the airways,
characterized by airflow obstruction,
bronchial hyperactivity, and a mucous
production.

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Bronchial asthma

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Risk factors for asthma
 Positive family history
 Allergy ( strongest risk factor)
 Chronic exposure to airway irritants or
allergens

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Triggers of bronchial asthma
 Allergens
 Exercise ( Exercise induced asthma) EIA
 Respiratory Infections
 Nose and Sinus problems
 Drugs and Food Additives
 GERD ( Gastro esophageal disorder)
 Emotional Stress

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Pathophysiology of bronchial asthma

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Clinical Manifestations
 The three most common symptoms of asthma
are Cough ( esp. at night) Dyspnea, and
Wheezing. In some instances, cough may be
the only symptom. Asthma attacks often occur
at night or early in the morning, possibly due
to circadian variations that influence airway
receptor thresholds.

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Clinical Manifestations

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Assessment and Diagnostic Findings
 History collection (A complete family,
environmental, and occupational history is
essential. To establish the diagnosis)

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Assessment and Diagnostic Findings
 Occupation related to chemicals and
compounds
 Sputum culture
 Arterial blood gas analysis ( ABGs)
 Pulse oximetrey
 Pulmonary functions test (PFT)

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Assessment and Diagnostic Findings
 Peak flow monitoring (peak expiratory
flow test or PEF)
 Incentive spirometer

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Peak flow monitoring
 A peak flow meter is a portable, easy-to-use
device that measures how well your lungs are
able to expel air. By blowing hard through a
mouthpiece on one end, the peak flow meter
can measure the force of air in liters per
minute and give you a reading on a built-in
numbered scale.

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Peak flow monitoring (peak expiratory flow
test or PEF)

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Method of peak flow monitoring

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Incentive spirometer
 Incentive spirometry, also referred to as
sustained maximal inspiration (SMI), is
a component of bronchial hygiene
therapy.

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Incentive spirometer

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Method of using incentive spirometry

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Prevention of asthma triggers
 Knowledge is the key to quality asthma
care. Although national guidelines are
available for the care of the asthma
patient, unfortunately health care
providers may not follow them.

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Prevention
 Patients with recurrent asthma should
undergo tests to identify the substances that
precipitate the symptoms.
 Possible causes are dust, dust mites,
roaches, certain types of cloth, pets, horses,
detergents, soaps, certain foods, molds, and
pollens. If the attacks are seasonal, pollens
can be strongly suspected. The patient is
instructed to avoid the causative agents
whenever possible.

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COMPLICATIONS OF BRONCHIAL
ASTHMA
1. STATUS ASTHMATICUS
2. RESPIRATORY FAILURE
3. PNEUMONIA
4. ATELECTASIS.

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Complications
 Airway obstruction, particularly during acute
asthmatic episodes, often results in
hypoxemia, requiring the administration of
oxygen and the monitoring of pulse oximetry
and arterial blood gases. Fluids are
administered because people with asthma
are frequently dehydrated from diaphoresis
and insensible fluid loss with hyperventilation.

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Medical Management client with
bronchial asthma
 Quality asthma care involves not only initial
diagnosis and treatment to achieve asthma
control, but also long-term, regular follow-up
care to maintain control.

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Medical Management client with
bronchial asthma.
 Immediate intervention is necessary
because the continuing and progressive
dyspnea leads to increased anxiety,
aggravating the situation.

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PHARMACOLOGIC THERAPY
 Two general classes of asthma
medications are Long-acting
medications to achieve and maintain
control of persistent asthma and Quick-
relief medications for immediate
treatment of asthma symptoms and
exacerbations

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Long-Acting Control Medications
 Long-Acting Control Medications.
Corticosteroids are the most potent and
effective anti-inflammatory medications
currently available. They are broadly effective
in alleviating symptoms, improving airway
function, and decreasing peak flow variability

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 Long-Acting Control Medications
Corticosteroids Mast cell stabilizers Long-
acting beta2-adrenergic agents XANTHINE
derivatives LEUKOTRIENE MODIFIERS
(inhibitors) Combination products .

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Quick-Relief Medications
 Quick-Relief Medications. Short-acting beta-
adrenergic agonists are the medications of
choice for relieving acute symptoms and
preventing exercise-induced asthma.
 They have a rapid onset of action.
Anticholinergics (eg, iPRATROPIUM BROMIDE
[Atrovent]) may bring added benefit in severe
exacerbations, but they are used more frequently
in COPD patients.

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MANAGEMENT OF ASTHMA
EXACERBATION
 Asthma exacerbations are best managed by
early treatment and education of the patient is
essential.
 Systemic corticosteroids may be necessary to
decrease airway inflammation in patients who
fail to respond to inhaled beta-adrenergic
medications.

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MANAGEMENT OF ASTHMA
EXACERBATION
 In some patients, oxygen supplementation
may be required to relieve hypoxemia
associated with a moderate to severe
exacerbation

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MANAGEMENT OF ASTHMA
EXACERBATION
 A written action plan is the most useful tool for
the patient.
 This helps to guide the patient in self-
management strategies regarding an
exacerbation and also provides instructions
regarding recognition of early warning signs
of worsening asthma
PEAK FLOW MONITORING

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PEAK FLOW MONITORING
 Peak flow meters measure the highest airflow
during a forced expiration .


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PEAK FLOW MONITORING
 Daily peak flow monitoring is recommended for
all patients with moderate or severe asthma
because it helps measure asthma severity and,
when added to symptom monitoring, indicates
the current degree of asthma control.
 The patient is instructed in the proper technique,
particularly to give maximal effort.

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Nursing management client with
bronchial asthma
 The immediate nursing care of the patient
with asthma depends on the severity of the
symptoms.
 The patient may be treated successfully as an
outpatient if asthma symptoms are relatively
mild, or he or she may require hospitalization
and intensive care for acute and severe
asthma

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Nursing management client with
bronchial asthma
 The patient and family are often frightened
and anxious because of the patient’s
dyspnea. Thus, an important aspect of care is
a calm approach.

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Nursing management client with
bronchial asthma
 The nurse assesses the patient’s respiratory
status by monitoring the severity of
symptoms, breath sounds, peak flow, pulse
oximetry, and vital signs. The nurse obtains a
history of allergic reactions to medications
before administering medications and
identifies the patient’s current use of
medications.

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Nursing management client with
bronchial asthma
 The nurse administers medications as
prescribed and monitors the patient’s
responses to those medications.
 Fluids may be administered if the patient is
dehydrated, and antibiotic agents may be
prescribed if the patient has an underlying
respiratory infection.

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Nursing management client with
bronchial asthma
 If the patient requires intubation because of
acute respiratory failure, the nurse assists
with the intubation procedure, continues close
monitoring of the patient, and keeps the
patient and family informed about procedures.

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Patient teaching regarding Asthma
 Patient teaching is a critical component of
care for the patient with asthma.
 Multiple inhalers, different types of inhalers,
antiallergy therapy, antireflux medications,
and avoidance measures are all integral for
long-term control.

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Components of Patient teaching
 The nature of asthma as a chronic
inflammatory disease
 The definition of inflammation and
bronchoconstriction.
 The purpose and action of each
medication
 Triggers to avoid, and how to do so

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Components of Patient teaching
 Proper inhalation technique
 How to perform peak flow monitoring
 How to implement an action plan
 When to seek assistance, and how
to do so

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STATUS ASTHMATICUS
 A severe form of asthma in which the
airway obstruction is unresponsive
to usual drug therapy.

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 A prolonged severe attack of asthma
that is unresponsive to initial
standard therapy, is characterized
especially by dyspnea, dry cough,
wheezing, and hypoxemia, and that
may lead to respiratory failure

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Causes of status asthmaticus
The attacks can last longer than 24 hours.
 Infection
 Anxiety
 Nebulizer abuse,
 Dehydration
 Increased adrenergic blockage and nonspecific
irritants may contribute to these episodes.

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Clinical Manifestations
The clinical manifestations are the same as those
seen in severe asthma:
 Labored breathing
 Prolonged exhalation
 Engorged neck veins and wheezing and
leading to respiratory failure

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Assessment and Diagnostic Findings
 Pulmonary function studies are the most
accurate means of assessing acute airway
obstruction.
 Arterial blood gas (ABGs) measurements are
obtained if the patient cannot perform
pulmonary function maneuvers because of
severe obstruction or fatigue, or if the patient
does not respond to treatment.

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Medical Management client with Status
asthmaticus
 In the emergency setting, the patient is
treated initially with a short-acting beta-
adrenergic agonist and corticosteroids.
 The patient usually requires supplemental
oxygen and intravenous fluids for hydration.

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Medical Management client with Status
asthmaticus
 Oxygen therapy is initiated to treat dyspnea,
central cyanosis, and hypoxemia.
 Humidified oxygen by either Venturi mask or
nasal catheter is administered. The flow is based
on pulse oximetry or arterial blood gas values.
 If there is no response to repeated treatments,
hospitalization is required.

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Nursing Management
 The nurse constantly monitors the patient for the first
12 to 24 hours, or until status asthmaticus is under
control.
 The nurse also assesses the patient’s skin turgor to
identify signs of dehydration.
 Fluid intake is essential to combat dehydration, to
loosen secretions, and to facilitate expectoration.


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Nursing Management
 The nurse administers intravenous fluids as
prescribed, up to 3 to 4 L/day, unless
contraindicated.
 The patient’s energy needs to be conserved,
and the room should be quiet and free of
respiratory irritants, including flowers, tobacco
smoke, perfumes, or odors of cleaning
agents. A non-allergenic pillow should be
used.