1. Running head: ACUTE SEVERE ASTHMA 1
Acute Severe Asthma
Breanna Hernandez
California Baptist University
Author’s Note
This paper is presented to Professor Toro in partial fulfillment for the requirements of
Adult Health II , NUR 440 A, on February 3rd, 2016.

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Acute Severe Asthma
Asthma, a chronic inflammatory disease of the airways, affected over 17 million
American adults in 2009 (Porth & Matfin, 2009; Morton & Fontaine, 2012). This air way
disorder causes obstruction, bronchial hyperresonsiveness, airway inflammation, and possibly
even airway remolding (Porth & Matfin, 2009). Asthma results in over 2 million emergency
department visits and about 5000 deaths every year in the United States (Morton & Fontaine,
2012). It is said that most cases were medical intervention of asthma episodes is required are
preventable (Morton & Fontaine, 2012).
Pathophysiology
Asthma is usually seen by inflammation in the bronchial trees, large airways and in the
alveoli (Morton & Fontaine, 2012). The inflammation is caused from mast cell activation,
edema, damage to the bronchial epithelium, and the thickening of smooth muscle (Porth &
Matfin, 2009). The two types of T lymphocytes, also known as t helper cells, play a big role in
the inflammatory process (Morton & Fontaine, 2012). “T1H cells differentiate in response to
microbes and stimulate the differentiation of B cells into immunoglobulin (Ig)M- and IgG-
producing plasma cells”(Porth & Matfin, 2009, p. 969) to protect against inflammation. The role
of T2H cells is to promote the development of air way inflammation (Morton & Fontaine, 2012).
People with allergic asthma may have possible differentiation that is altered to the T2H response
(Porth & Matfin, 2009). It is said to be unclear as to what causes the differentiation between T
lymphocytes, but it can be attributed to genetic and environmental responses (Porth & Matfin,
2009)
It is common for someone to inhale dust particles, smoke or environmental pollutants and
then experience an asthma symptoms in response (Morton & Fontaine, 2012). When these

3. ACUTE SEVERE ASTHMA Hernandez-3
irritants get in the respiratory tract it causes bronchoconstriction (Morton & Fontaine, 2012).
The most common cause of an acute asthmatic exacerbation is a respiratory tract viral infection,
but bacteria, obesity, allergens, NSAIDs, and tracheobronchitis are also common causes (Morton
& Fontaine, 2012).
Laboratory Tests
The tests used to diagnose asthma are spirometry measurements, pulmonary functioning
tests, and in some cases allergy testing can be used to find specific allergens that cause asthma
exacerbations (Morton & Fontaine, 2012). Spirometry measurements allow medical providers to
see if an airflow obstruction is present (Morton & Fontaine, 2012). If after inhaling a short acting
bronchodilator there is an increase of 200 ml in FEV1 (a measurement of spirometry) then the
diagnosis of asthma can be made (Morton & Fontaine, 2012).
Signs and Symptoms/ Progression
People with asthma show a wide variety of signs and symptoms when experiencing an
asthma episode and it also may depend on the severity of the attack. Those who experience mild
asthma may show symptoms like agitation, breathlessness upon walking, increased RR rate,
expiratory wheezing, and heart rate less than 100 bpm that occur once a week but less than once
per day ( Morton & Fontaine, 2012). Moderate asthma exacerbation symptoms can occur daily,
these symptoms include breathless while talking, agitation, an increased respiratory rate, loud
wheezing, use of accessory muscles and a heart rate of 100-120 bpm (Morton & Fontaine, 2012).
Severe asthma exacerbations occur daily and frequently which limit physical activities.
Symptoms of severe asthma include breathlessness at rest, agitation, a respiratory rate higher
than 30 breaths/min, loud wheezing, use of accessory muscles, and a heart rate greater than 120
bpm (Morton & Fontaine, 2012). Other symptoms that aren’t physically seen are chest tightness,

4. ACUTE SEVERE ASTHMA Hernandez-4
inflammation and swelling of lining in the airways, and variable airflow obstruction (Kaufman,
2012).
Asthma can progress from any level of severity all the way to respiratory failure if not
properly managed. It is important to know the severity of a patient’s asthma so proper treatment
can be given. If the inflammation due to asthma isn’t controlled it can lead to death cause by
respiratory failure (Kaufman, 2012; Morton & Fontaine, 2012). Respiratory failure occurs
suddenly and is characterized by the deterioration of gas exchange in the lungs that results in the
retention of carbon dioxide and insufficient oxygenation (Morton & Fontaine, 2012).
Medications
Although treatment for asthma depends on its severity the medications used to control
and manage it remain the same (Morton & Fontaine, 2012). These medications include short and
long acting B2 agonists (bronchodilators), leukotriene receptor antagonists, and corticosteroids
(anti-inflammatory drugs) (Deakins, 2015). These drugs together work together to cause
bronchodilation, reduce asthma exacerbations and reduce inflammation (Vallerand, Sanoski, &
Deglin, 2016).
Examples of B2 agonists include Levalbuterol, Salbutamol, Terbutaline, and Bambuterol
(Morton & Fontaine, 2012). Levalbuterol is a short acting drug given as two inhalations every
four to six hours to relax the smooth muscle in the airway (Vallerand, Sanoski, & Deglin, 2016).
Terbutaline, on the other hand, is a long acting drug that is given by mouth or injection
(Vallerand, Sanoski, & Deglin, 2016). This drug is given in doses of 2.5-5 mg three times daily
to achieve bronchodilation (Vallerand, Sanoski, & Deglin, 2016). Montelukast and Zafirlukast
are examples of Leukotriene antagonists which are used to manage seasonal allergic rhinitis and
to decrease the frequency of acute asthma attacks (Morton & Fontaine, 2012; Vallerand, Sanoski,

5. ACUTE SEVERE ASTHMA Hernandez-5
& Deglin, 2016). Montelkulast is specifically given by mouth 10 mg once every day (Vallerand,
Sanoski, & Deglin, 2016). Corticosteroids like Prednisone, Prednisolone, Hydrocortisone, and
Methylprednisolone are administered to suppress inflammation (Vallerand, Sanoski, & Deglin,
2016). Prednisone is given by mouth as a 5-60 mg tablet as a single daily dose or in some cases it
is ordered in divided doses (Vallerand, Sanoski, & Deglin, 2016).
Nursing Diagnosis/Interventions
Priority nursing diagnoses related to acute severe asthma are specific to the airway.
Having a clear airway is essential for proper oxygenation and gas exchange. Some nursing
diagnoses include ineffective airway clearance, ineffective breathing pattern and anxiety (Ralph
& Taylor, 2014). Interventions like assessing “respiratory status at least every 4 hours” (Ralph &
Taylor, 2014, p. 14) and administering oxygen can be used to clear the airway (Ralph & Taylor,
2014). Because a patient is exhibiting signs of impaired gas exchange, it is important to use
interventions like assessing and recording “pulmonary status every 4 hours or more frequently if
the patient is unstable” (Ralph & Taylor, 2014, p. 130) and placing the patient “in [a] position
that best facilitates chest expansion” (Ralph & Taylor, 2014, p.130). A patient may also be
feeling anxiety associated to the asthma attack so it is important to “identify and reduce as many
environmental stressors as possible” (Ralph & Taylor, 2014, p. 23) and to give the patient a clear
explanation of procedures that will occur (Ralph & Taylor, 2014).
Conclusion
Asthma affects many people around the world and in the United States. It accounts for
over 2 million hospital visits every year in the U.S., most of which could be preventable with
proper treatment and management. Because asthma is seen on different levels of severity
controlling the lifelong disease take careful medication and treatment. Teaching about how to

6. ACUTE SEVERE ASTHMA Hernandez-6
manage this airway disease in those who have been diagnosed can help reduce the amount of
emergency department visits and overall help the wellness of the community.
Personal Story
January 14, 2016 was the day I was diagnosed with something that could potentially alter
the rest of my life. I awoke just like every other day, dreading to get out of my warm and cozy
bed to get to class on time. I got ready as usual and exited the front door. While I was driving to
class I remember thinking to myself about how beautiful and sunny the day was. I parked my car
and began my long treacherous walk to class from the Lancer Plaza.
It came suddenly and I was unable to control it. My chest became tight and I was gasping
for air. All I could feel was my throat closing and a feeling of impending doom. I hunched over
as I unsuccessfully tried to regain control of my heaving breathing. I was so scared at this point
because I was unsure of what was happening to me. Before, I could realize what was going on
around me I was carted off into an ambulance and taken to the emergency department.
In the emergency room I was given medication and oxygen to clear my air way and help
me breath normally again. After this whole ordeal passed and I was stable, a doctor came in a
told me that I have acute severe asthma. Because the attack happened when I was doing minimal
physical activity, it was thought to be caused my allergens.
Now that I knew what had happened to me I felt a slight sense of relief but I was still
very scared and anxious about what this meant for my future. I am currently a nursing student
and having an illness as severe as this one could change everything I plan to accomplish. I had
already missed two days of school because of the asthma attack and now I was being sent home
on a medication regimen that included PO meds on a daily basis (I can’t swallow pills  ).
After doing research I believe that I will be able to continue nursing school and clinical
but it will consist of many struggles and a strict adherence to my medication regimen to keep my

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asthma under control. If my asthma isn’t controlled I may have to take a semester off and come
back in the fall.
As I reflect on this life changing event I think about the possibility of a higher power. I
don’t know God nearly as well as my classmates but I still ponder on the idea because deep
down I want there to be a God. I want my life to have meaning and a purpose. During this tough
time in my life I asked my roommate and she helped me with this one verse from 1 Peter 5:7 that
said “cast all your anxieties on him because he cares for you”. It helped me realize that maybe I
shouldn’t focus so much on the anxiety related to not knowing. It was unexpected to have
someone truly listen to me and help me on a spiritual level as well as physical and emotional.
She was truly present and actively listened to what I was saying and needing at the time
(Pilkington & Simpson, 2009, p.87). I think that because my views are limited biblically I will be
able to use this new diagnosis to explore my spiritual self. Maybe now I have found the perfect
time in my life to turn to God and truly get to know who he is.

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References
Deakins, K. M. (2015). Year in Review 2014: Asthma. Respiratory Care, 60(5), 744-748 5p.
doi:10.4187/respcare.04088
Kaufman, G. (2012). Asthma update: recommendations for diagnosis, treatment and
management. Primary Health Care, 22(5), 32-39 8p
Porth,. C., Matfin, G. ( 2009) Pathophysiology: Concepts of altered health status
(9thedition).Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
Morton, P. G. & Fontaine, D. K., (2012) Critical Care Nursing: A Holistic Approach (10th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Ralph, S. S., & Taylor, C. M. (2014). Nursing diagnosis reference manual (9th ed.).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2016). Davis's Drug Guide for Nurses (14th
ed.). F.A. Davis Company.