INTRODUCTION:

Asthma is a lower respiratory tract disease;it is an pulmonary obstructive disease.It is also called as “REACTIVE AIRWAY DISEASE

DEFINITION:

Asthma  is a common chronicinflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath

INCIDENCE:

It can occur in any age and in any sex26 million are diagnosed with asthma

every year10.6 million people are affectedWomens are increased risk of death

compare to menIn India 4000-6000 are dying every year

with asthma

TYPES:

ETIOLOGY:

Idiopathic

CAUSES:

RISK FACTORS:

HereditaryAllergensAirpollutantsUpper respiratory tract infectionsDrug over dosageOccupational exposuresEnvironmental factorsPsychological factors

PATHOPHYSIOLOGY:

CLINICAL MANIFESTATIONS:

WheezingCoughChest tightnessDysponeHypoxiaNasal flaringSputum is thick and tenaciousDecreased or absence of breath sounds

called “SILENT CHEST”

SYMPTOMS:

ASSESSMENT AND DIAGNOSTIC STUDIES:History collectionPhysical examinationPulse oximetryPulmonary function testArterial blood gasComplete blood countChest x-ray

MANAGEMENT:

Medications: Bronchodilators:

-long acting beta adrenagic blockers:

eg:salmeterol,formeterol,theophylline Anti-inflammatory drugs:

-corticosteriods:

eg:flunisolides,beclamethasone,cromolyn

-Mast cell stabilizers:

eg:montelukast,zileuton DRY POWDER INHALERS

CORTICOSTEROIDS ARE MOST EFFECTIVE

DELIVERY METHODS:

Medications are typically provided as metered-dose inhalers (MDIs) in combination with an asthma spacer or as a dry powder inhaler. The spacer is a plastic cylinder that mixes the medication with air, making it easier to receive a full dose of the drug. A nebulizer may also be used.

ADVERSE EFFECTS:

Long-term use of inhaled corticosteroids at conventional doses carries a minor risk of adverse effects.Risks include the development of cataracts and a mild regression in stature.

OTHER METHODS:

When asthma is unresponsive to usual medications, other options are available for both emergency management and prevention of flareups. For emergency management other options include:

Oxygen to alleviate hypoxia if saturations fall below 92%.

Oral corticosteroid are recommended with five days of prednisone being the same 2 days of dexamethasone.

Magnesium sulfate intravenous treatment has been shown to provide a bronchodilating effect when used in addition to other treatment in severe acute asthma attacks.

Heliox, a mixture of helium and oxygen, may also be considered in severe unresponsive cases

COMORBIDITES:

NURSING MANAGEMENT:

Check vitalsigns at regular intervals. Monitor allergic symptoms. Administer medication, note action of

medications. Avoid exposure to pollution environment. Deep breathing exercises. Health education.

NURSING DIAGNOSIS:

Ineffective airway cleareance related to bronchospasm.

Impaired breathing pattern related to excessive mucus secretion.

Sleep pattern disturbance related to cough and dysponea.

Anxiety related to difficulty in breathing.Knowledge deficit related to treatment

regimen.

yamini