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-Intermittent, irreversible airway obstruction

-Its onset is sudden as opposed to the slowinsidious progression of symptoms seen in bronchitis and emphysema

-Increase responsiveness if trachea and bronchi to various stimuli

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-is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction,and bronchospasm.

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D yspnea

Cough

Sputum

Chest Pain

History on cigarette smoking

wheezing

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E nvironmental Factors (change in temperature)

Atmospheric Pollutants (industrial and cigarettesmoke)

Stress and E motional Upset

Allergens (animal dander, dust mites)

Viral respiratory infections may increase one's risk of developing asthma

maternal cigarette smoking, is associated with high risk of asthma prevalence

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Altered Immunologic Response

Basis of Asthma : May be genetic or immunologic Immunologic asthma result of an antigen antibody reaction in which chemical mediators are released

Reactions: 1. Constriction of smooth muscles of both the large and small airways, resulting in bronchospasms 2. Increased capillary permeability that results in

mucosal edema and further narrows the airways

3. Increase mucus gland secretion and increase mucus production

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Increased airway resistance

Results from muscle spasm, mucosal inflammation and hyper secretion of mucus

Altered Oxygen and Carbon D ioxideE xchangeIncreased airway resistance and hyperinflation that cause respiratory muscles to work harder resulting in

muscle fatigue and ultimately exhaustion.

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Primary goal of treatment:

To promote normal unctioning of the individual,revent recurrent symptoms,revent severe attacks and revent side effects from

medications

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Pharmacological:

Inhaled B-agonist (albuterol sulfate, ventalin) it stimulates b2 receptors in bronchial smooth muscle resulting in relaxation

Methylprendnisolonereduces inflammation and edema of airway and

decreases hyperactivity of airway

Bronchodilators(ephinephrine, ephedrine)

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Complications:

Spasms of theextremities

Tachycardia

Headache

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u A clear history of hypersensitivity to some known substancethat may be inhaled or ingested-particular type of food, feathers,animal hair, face powder, or such a history suggesting the

probability of such sensitivity.u Close association of the attacks with allergic rhinitis, mark

pallor, and swelling of the nasal mucous membrane aids in establishing the case as one of the extrinsic allergic asthma.

u Finding of an abnormally high count of eosinophilic cells in theblood or the sputum tends to confirm this diagnostic impression.

u Bloood gas evaluatiom and simple spirometry useful in evaluating gas exchange and providing baseline data that assist in identifying dangerous hypoxemia and respiratory acidosis.

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u Physical exertion- may induce acute bronchospasms in most patients with asthma. The key factors appears to be heat loss from the respiratory tract induced by hyperventilation.

u Testing in Pulmonary function laboratory can usually provide objective evidence of airway

obstruction.u Often a diagnosis is confirmed by instructing the

patient to inhale a trial aerosol bronchodilator (during a coughing episode)

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Improving Airway Clearance:

1. E nsure adequate systemic fluid intake

2. Provide adequate nutritional levels

3. Provide extra humidity

4. Medicate with bronchodilators

5. Teach effective cough maneuver

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Providing E motional Support and Preventing Anxiety

1. Never leave patient alone during an asthmatic attack

2. E ncourage relaxation techniques

3. Give/Assist the patient with respiratory maneuvers

4. Assess for possible medication overuse

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Improving Breathing Patterns

Improving gas exchange1. If respiratory alkalosis is present, encourage slower breathing

2. If respiratory acidosis and hypoxemia are present: -administer oxygen as prescribed -if oxygen is not relieve the attack, intubations and ventilatory assistance may be required

Facilitating Learning

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Symptoms: Mild wheeze, cough, chest tightness, shortness of breath occurring with

activity but not at rest Peak Flow: 70-90% of baseline (personal best or predicted, as determined by clinician)

Actions: Take inhaled bronchodilator. If improved, continue medication on regular basis for 24-28 hours

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Symptoms: wheeze cough, chest tightness, shortness of breath while at rest; symptoms may interfere with daily activity

Peak Flow: 50-70% of baseline

Actions: Repeat inhaled bronchodilator every 20 mins.For 1 hour. If improved, continue medication every 3-4hours for 24-28 hours. If not improved in 2-6 hours after initial treatment, begin or increased prednisone.Contact your physician

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Symptoms: Severe shortness of breath, wheeze(may disappear with very severe episode), cough , and chest tightness at rest; difficulty walking and talking; perhaps

retraction of muscles in chest or neck Peak flow: less than 50% of baseline and little response to bronchodilator

Actions: Repeat inhaled bronchodilator, 4-6 puffs, every 10mins up to 3 times. Begin or increased prednisone. If there is no significant improvement after 20-30 minutes,seek emergency care immediately. Be prepared: Have plan

for receiving emergency care quickly in the event of a

sudden episode. Keep emergency phone numbers handy.Always carry an inhaler if bronchodilator with you.

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