UNIVERSITY OF MINDANAOCollege of NursingMatina, Davao City

Title Page: Table of Contents:Acknowledgment:Introduction:Objectives of the Study:

Identification of the Case:

Patient’s Code Name: Mrs. XCase No.: 2009040124Ward: OB WardBed No.: 44Date of Admission: August 01, 2009Reason’s of Admission: Labor painDate of Discharge (if discharge): Admitting Diagnosis: S/P 1º LSTCS For CDD; Pregnancy Uterine 37 5/7 weeks AOG Alpha in Latent Phase of LaborG2P1 (1001) Cap- Mr , Ba IN AEPrincipal Diagnosis: Status Post CS 1 for Cephalopelvic disproportion, pregnancy uterine term cephalic live birth baby boy G2p2 Intrauterine growth retardation; with acquired community pneumonia; bronchial asthma in acute exacerbationPre op Diagnosis: S/P LSTCSSurgical Procedure Performed: LSTCS 11

Date: 08-01-09 Time started: 11:00am Time ended: 12:20am

Attending Physicians: Dr. Orobello, Dr. Flavier, Dr. Reyna Marie C. HerreraDate study begun: August 3, 2009`Date study ended: August 4, 2009Time spent in actual nursing care to patient: 16 hoursSources of information/informant/s: Patient, patients husband, patients mother, patients chart and recordsFamily Background/ History: (to include history of heredofamilial disease)

Mrs. X is a 35 y.o. female living at Sabang, Poblacion Malita, Davao del Sur. She has one 8 y.o daughter. She is just a plain housekeeper. Her family is a protestant. Her family has a history of a respiratory problem. They are known to be asthmatic. Her family also has a history of kidney failure.

Socioeconomic Background:Mrs. X is a plain housekeeper, she just stay at home taking good care of her 8

year old girl.

OB-GYNE History: (for female patients) Obstetrical Sheet

Obstetrical History G2P2A0

Pregnancy order Pregnancy outcome Year Gestation Completed Wks/ Delivery

G1____ CS 2002 Full Term (FT)P2____Sex: F Present Status

LivingDesired Family Size: 2Contraceptive history: noneEducational Profession: SecondarySocio-Economic Prof.: Dependent/unemployed incomePresent pregnancy:

LMP: November 2008EDC: August 16, 2009AOG: 37 5/7 wks

Menstrual Cycle:Menarche: 12 y.o. ; Regular; x 4-5 days duration

Antenatal visit: >5Health Care provider: MCH-DDH-GOImmunization: TT 1Medication: Iron Vitamins+ Cough x 1 week, consulted yesterday at ER given terbutaline and nebulization as THM

Department of OB & Gyne (Increase Risk Evaluation Form)Age: 35 y.o.Parity: 1Previous CS: Section 2

TOTAL SCORE: 2LOW RISK

Antenatal Problems: Respiratory (known asthmaticRisk Status:PE: Date 7/31/09 Time: 8:10 PMExaminer: Dr. Reyna Marie Chua- Herrera, MDVS as follows:

T: 36.5°CPR: 68bpmRR: 22 cpmBP: 120/80 mmHg

General Status: Well

Level of Sensorium: HEENT: OcyctenicscleraeConsciousCooperativeCoherent

Abdomen:LSKFundic Height: 30 cmPresentation: CephalicEFW: 2.6FHT: 140 bpmEngagement: Engaged

Pelvic Exam:External Genitalia: grosly normalVagina: grosly normal

Cervix Length: 2 cmEffacement: 40 %

Medical and Health History/Background: History of past illness/es

History of present illness/es

Developmental Tasks:

Middle Age(30-60)

In the middle years, from about thirty to about fifty-five, women reach the peak of their influence upon society, and at the same time the society makes its maximum demands upon them for social and civic responsibility. It is the period of life to which they have looked forward during their adolescence and early adulthood. And the time passes so quickly during these full and active middle years that most people arrive at the end of middle age and the beginning of later maturity with surprise and a sense of having finished the journey while they were still preparing to commence it.

The biological changes of ageing, which commence unseen and unfelt during the twenties, make themselves known during the middle years. Especially for the woman, the

latter years of middle age are full of profound physiologically-based psychological change.

The developmental tasks of the middle years arise from changes within the organism, from environmental pressure, and above all from demands or obligations laid upon the individual by his own values and aspirations.

Since most middle-aged people are members of families, with teen-age children, it is useful to look at the tasks of husband, wife, and children as these people live and grow in relation to one another. A woman has several functions or roles in the family and these are being a woman, a wife, a mother, a homemaker and a family manager.

1) Achieving adult civic and social responsibility2) Establishing and maintaining an economic standard of living3) Assisting teen-age children to become responsible and happy adults4) Developing adult leisure-time activities5) Relating one

2) self to one's spouse as a person6) Accepting and adjusting to the physiological changes of middle age7) Adjusting to ageing parents 

Definition of terms:Anatomy and Physiology:

Function of the Respiratory System

The function of the respiratory system is to deliver air to the lungs. Oxygen in the air diffuses out of the lungs and into the blood, while carbon dioxide diffuses in the opposite direction, out of the blood and into the lungs. Respiration includes the following processes:

Pulmonary ventilation is the process of breathing—inspiration (inhaling air) and expiration (exhaling air).

External respiration is the process of gas exchange between the lungs and the blood. Oxygen diffuses into the blood, while CO2 diffuses from the blood into the lungs.

Gas transport, carried out by the cardiovascular system, is the process of distributing the oxygen throughout the body and collecting CO2 and returning it to the lungs.

Internal respiration is the process of gas exchange between the blood, the interstitial fluids (fluids surrounding the cells), and the cells. Inside the cell, cellular respiration generates energy (ATP), using O2 and glucose and producing waste CO2.

Structure of the Respiratory System

The respiratory system

The nose consists of the visible external nose and the internal nasal cavity. The nasal septum divides the nasal cavity into right and left sides. Air enters two openings, the external nares (nostrils; singular, naris), and passes into the vestibule and through passages called meatuses. The bony walls of the meatuses, called concha, are formed by facial bones (the inferior nasal concha and the ethmoid bone). From the meatuses, air then funnels into two (left and right) internal nares. Hair, mucus, blood capillaries, and cilia that line the nasal cavity filter, moisten, warm, and eliminate debris from the passing air.

The pharynx (throat) consists of the following three regions, listed in order through which incoming air passes:

o The nasopharynx receives the incoming air from the two internal nares. The two auditory (Eustachian) tubes that equalize air pressure in the middle ear also enter here. The pharyngeal tonsil (adenoid) lies at the back of the nasopharynx.

o The oropharyrnx receives air from the nasopharynx and food from the oral cavity. The palatine and lingual tonsils are located here.

o The laryngopharynx passes food to the esophagus and air to the larynx.

The larynx receives air from the laryngopharynx. It consists of the following nine pieces of cartilage that are joined by membranes and ligaments.

Anterior and sagittal section of the larynx and the trachea.

o The epiglottis, the first piece of cartilage of the larynx, is a flexible flap that covers the glottis, the upper region of the larynx, during swallowing to prevent the entrance of food.

o The thyroid cartilage protects the front of the larynx. A forward projection of this cartilage appears as the Adam's apple.

o The paired arytenoids cartilages in the rear are horizontally attached to the thyroid cartilage in the front by folds of mucous membranes. The upper vestibular folds (false vocal cords) contain muscle fibers that bring the folds together and allow the breath to be held during periods of muscular pressure on the thoracic cavity (straining while defecating or lifting a heavy object, for example). The lower vocal folds (true vocal cords) contain elastic ligaments that vibrate when skeletal muscles move them into the path of outgoing air. Various sounds, including speech, are produced in this manner.

o The cricoid cartilage, the paired cuneiform cartilages, and the paired corniculate cartilages are the remaining cartilages supporting the larynx.

The trachea (windpipe) is a flexible tube, 10 to 12 cm (4 inches) long and 2.5 cm (1 inch) in diameter, whose wall consists of four layers.

o The mucosa is the inner layer of the trachea. It contains mucusproducing goblet cells and pseudostratified ciliated epithelium. The movement of the cilia sweep debris away from the lungs toward the pharynx.

o The submucosa is a layer of areolar connective tissue that surrounds the mucosa.

o Hyaline cartilage forms 16 to 20 C-shaped rings that wrap around the submucosa. The rigid rings prevent the trachea from collapsing during inspiration.

o The adventitia is the outermost layer of the trachea. It consists of areolar connective tissue.

The primary bronchi are two tubes that branch from the trachea to the left and right lungs.

Inside the lungs, each primary bronchus divides repeatedly into branches of smaller diameters, forming secondary (lobar) bronchi, tertiary (segmental) bronchi, and numerous orders of bronchioles (1 mm or less in diameter), including terminal bronchioles (0.5 mm in diameter) and microscopic respiratory bronchioles. The wall of the primary bronchi are constructed like the trachea, but as the branches of the tree get smaller, the cartilaginous rings and the mucosa are replaced by smooth muscle.

Alveolar ducts are the final branches of the bronchial tree. Each alveolar duct has enlarged, bubblelike swellings along its length. Each swelling is called an alveolus, and a cluster of adjoining alveolar is called an alveolar sac. Some adjacent alveoli are connected by alveolar pores.

The respiratory membrane consists of the alveolar and capillary walls. Gas exchange occurs across this membrane. Characteristics of this membrane follow:

o Type I cells are thin, squamous epithelial cells that constitute the primary cell type of the alveolar wall. Oxygen diffusion occurs across these cells.

o Type II cells are cuboidal epithelial cells that are interspersed among the type I cells. Type II cells secrete pulmonary surfactant (a phospholipid bound to a protein) that reduces the surface tension of the moisture that covers the alveolar walls. A reduction in surface tension permits oxygen to

diffuse more easily into the moisture. A lower surface tension also prevents the moisture on opposite walls of an alveolus or alveolar duct from cohering and causing the minute airway to collapse.

o Alveolar macrophage (dust cells) wander among the other cells of the alveolar wall removing debris and microorganisms.

o A thin epithelial basement membrane forms the outer layer of the alveolar wall.

o A dense network of capillaries surrounds each alveolus. The capillary walls consist of endothelial cells surrounded by a thin basement membrane. The basement membranes of the alveolus and the capillary are often so close that they fuse.

Lungs

The lungs are a pair of cone-shaped bodies that occupy the thorax . The mediastinum, the cavity containing the heart, separates the two lungs. The left and right lungs are divided by fissures into two and three lobes, respectively. Each lobe of the lung is further divided into bronchopulmonary segments (each with a tertiary bronchus), which are further divided into lobules (each with a terminal bronchiole). Blood vessels, lymphatic vessels, and nerves penetrate each lobe.

Each lung has the following superficial features:

The apex and base identify the top and bottom of the lung, respectively. The costal surface of each lung borders the ribs (front and back).

On the medial (mediastinal) surface, where each lung faces the other lung, the bronchi, blood vessels, and lymphatic vessels enter the lung at the hilus.

The pleura is a double membrane consisting of an inner pulmonary (visceral) pleura, which surrounds each lung, and an outer parietal pleura, which lines the thoracic cavity. The narrow space between the two membranes, the pleural cavity, is filled with pleural fluid, a lubricant secreted by the pleura.

Mechanics of Breathing

Boyle's law describes the relationship between the pressure (P) and the volume (V) of a gas. The law states that if the volume increases, then the pressure must decrease (or vice versa). This relationship is often written algebraically as PV= constant, or P1V1 = P2V2. Both equations state that the product of the pressure and volume remains the same. (The law applies only when the temperature does not change.)

Breathing occurs when the contraction or relaxation of muscles around the lungs changes the total volume of air within the air passages (bronchi, bronchioles) inside the lungs. When the volume of the lungs changes, the pressure of the air in the lungs changes in accordance with Boyle's law. If the pressure is greater in the lungs than outside the lungs, then air rushes out. If the opposite occurs, then air rushes in. Here is a summary of the process:

Inspiration occurs when the inspiratory muscles-that is, the diaphragm and the external intercostals muscles-contract. Contraction of the diaphragm (the skeletal muscle below the lungs) causes an increase in the size of the thoracic cavity, while contraction of the external intercostals muscles elevates the ribs and sternum. Thus, both muscles cause the lungs to expand, increasing the volume of their internal air passages. In response, the air pressure inside the lungs decreases below that of air outside the body. Because gases move from regions of high pressure to low pressure, air rushes into the lungs.

Expiration occurs when the diaphragm and external intercostal muscles relax. In response, the elastic fibers in lung tissue cause the lungs to recoil to their original volume. The pressure of the air inside the lungs then increases above the air pressure outside the body, and air rushes out. During high rates of ventilation, expiration is facilitated by contraction of the expiratory muscles (the intercostals muscles and the abdominal muscles).

Lung compliance is a measure of the ability of the lungs and thoracic cavity to expand. Due to the elasticity of lung tissue and the low surface tension of the moisture in the lungs (from the surfactant), the lungs normally have high compliance.

Lung Volumes and Capacities

The following terms describe the various lung (respiratory) volumes:

The tidal volume (TV), about 500 ml, is the amount of air inspired during normal, relaxed breathing.

The inspiratory reserve volume (IRV), about 3,100 ml, is the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume.

The expiratory reserve volume (ERV), about 1,200 ml, is the additional air that can be forcibly exhaled after the expiration of a normal tidal volume.

Residual volume (RV), about 1,200 ml, is the volume of air still remaining in the lungs after the expiratory reserve volume is exhaled.

Summing specific lung volumes produces the following lung capacities:

The total lung capacity (TLC), about 6,000 ml, is the maximum amount of air that can fill the lungs (TLC = TV + IRV + ERV + RV).

The vital capacity (VC), about 4,800 ml, is the total amount or air that can be expired after fully inhaling (VC = TV + IRV + ERV = approximately 80% TLC).

The inspiratory capacity (IC), about 3,600 ml, is the maximum amount of air that can be inspired (IC = TV + IRV).

The functional residual capacity (FRC), about 2,400 ml, is the amount of air remaining in the lungs after a normal expiration (FRC = RV + ERV).

Some of the air in the lungs does not participate in gas exchange. Such air is located in the anatomical dead space within bronchi and bronchioles—that is, outside the alveoli.

Gas Exchange

In a mixture of different gases, each gas contributes to the total pressure of the mixture. The contribution of each gas, called the partial pressure, is equal to the pressure that the gas would have if it were alone in the enclosure. Dalton's law states that the sum of the partial pressures of each gas in a mixture is equal to the total pressure of the mixture.

The following factors determine the degree to which a gas will dissolve in a liquid:

The partial pressure of the gas. According to Henry's law, the greater the partial pressure of a gas, the greater the diffusion of the gas into the liquid.

The solubility of the gas. The ability of a gas to dissolve in a liquid varies with the kind of gas and the liquid.

The temperature of the liquid. Solubility decreases with increasing temperature.

Gas exchange occurs in the lungs between alveoli and blood plasma and throughout the body between plasma and interstitial fluids. The following factors facilitate diffusion of O2 and CO2 at these sites:

Partial pressures and solubilities. Poor solubility can be offset by a high partial pressure (or vice versa). Compare the following characteristics of O2 and CO2:

o Oxygen. The partial pressure of O2 in the lungs is high (air is 21% O2), but is solubility poor.

o Carbon dioxide. The partial pressure of CO2 in air is extremely low (air is only 0.04% CO2), but its solubility in plasma is about 24 times that of O2.

Partial pressure gradients. A gradient is a change in some quantity from one region to another. Diffusion of a gas into a liquid (or the reverse) occurs down a partial pressure gradient-that is, from a region of higher partial pressure to a region of lower partial pressure. For example, the strong partial pressure gradient for O2 (pO2) from alveoli to deoxygenated blood (105 mm Hg in alveoli versus 40 mm Hg in blood) facilitates rapid diffusion.

Surface area for gas exchange. The expansive surface area of the lungs promotes extensive diffusion.

Diffusion distance. Thin alveolar and capillary walls increase the rate of diffusion.

Gas Transport

Oxygen is transported in the blood in two ways:

A small amount of O2 (1.5 percent) is carried in the plasma as a dissolved gas. Most oxygen (98.5 percent) carried in the blood is bound to the protein

hemoglobin in red blood cells. A fully saturated oxyhemoglobin (HbO2) has four O2 molecules attached. Without oxygen, the molecule is referred to as deoxygemoglobin (Hb).

The ability of hemoglobin to bind to O2 is influenced by the partial pressure of oxygen. The greater the partial pressure of oxygen in the blood, the more readily oxygen binds to Hb. The oxygen-hemoglobin dissociation curve, shown in Figure 1 , shows that as pO2 increases toward 100 mm Hg, Hb saturation approaches 100%. The following four factors decrease the affinity, or strength of attraction, of Hb for O2 and result in a shift of the O2-Hb dissociation curve to the right:

The oxygen-hemoglobin dissociation curve.

Increase in temperature. Increase in partial pressure of CO2 (pCO2).

Increase in acidity (decrease in pH). The decrease in affinity of Hb for O2, called the Bohr effect, results when H+ binds to Hb.

Increase in BPG in red blood cells. BPG (bisphosphoglycerate) is generated in red blood cells when they produce energy from glucose.

Carbon dioxide is transported in the blood in the following ways.

A small amount of CO2 (8 percent) is carried in the plasma as a dissolved gas. Some CO2 (25 percent) binds to Hb in red blood cells forming

carbaminohemoglobin (HbCO2). (The CO2 binds to a place different from that of O2.)

Most CO2 (65 percent) is transported as dissolved bicarbonate ions (HCO3-) in the plasma. The formation of HCO3-, however, occurs in the red blood cells, where the formation of carbonic acid (H2CO3-) is catalyzed by the enzyme carbonic anhydrase, as follows.

Following their formation in the red blood cells, most H+ bind to hemoglobin molecules (causing the Bohr effect) while the remaining H+ diffuse back into the plasma, slightly decreasing the pH of the plasma. The HCO3− ions diffuse back into the plasma as well. To balance the overall increase in negative charges entering the plasma, chloride ions diffuse in the opposite direction, from the plasma to the red blood cells (chloride shift).

Control of Respiration

Respiration is controlled by these areas of the brain that stimulate the contraction of the diaphragm and the intercostal muscles. These areas, collectively called respiratory centers, are summarized here:

The medullary inspiratory center, located in the medullar oblongata, generates rhythmic nerve impulses that stimulate contraction of the inspiratory muscles (diaphragm and external intercostal muscles). Normally, expiration occurs when these muscles relax, but when breathing is rapid, the inspiratory center facilitates expiration by stimulating the expiratory muscles (internal intercostal muscles and abdominal muscles).

The pheumotaxic area, located in the pons, inhibits the inspiratory center, limiting the contraction of the inspiratory muscles, and preventing the lungs from overinflating.

The apneustic area, also located in the pons, stimulates the inspiratory center, prolonging the contraction of inspiratory muscles.

The respiratory centers are influenced by stimuli received from the following three groups of sensory neurons:

Central chemoreceptors (nerves of the central nervous system), located in the medulla oblongata, monitor the chemistry of cerebrospinal fluid. When CO2 from the plasma enters the cerebrospinal fluid, it forms HCO3- and H+, and the pH of the fluid drops (becomes more acidic). In response to the decrease in pH, the central chemoreceptors stimulate the respiratory center to increase the inspiratory rate.

Peripheral chemoreceptors (nerves of the peripheral nervous system), located in aortic bodies in the wall of the aortic arch and in carotid bodies in the walls of the carotid arteries, monitor the chemistry of the blood. An increase in pH or pCO2, or decrease in pO2, causes these receptors to stimulate the respiratory center.

Stretch receptors in the walls of bronchi and bronchioles are activated when the lungs expand to their physical limit. These receptors signal the respiratory center to discontinue stimulation of the inspiratory muscles, allowing expiration to begin. This response is called the inflation (Hering-Breur) reflex.

Etiology and Symptomatology with Scientific Basis:A bronchial asthma sufferer finds it difficult to breathe because their air passages

feel inflamed and tight. Apart from those symptoms, someone who has bronchial asthma will also suffer painful wheezing, and long bouts of coughing which brings up mucus. Alleviating the symptoms is not just a matter of carrying an inhaler around with them all the time. Asthma attacks can be very awful as bronchial asthma sufferers are all too aware.

Most asthma sufferers are treated with asthma inhalators, which are devices fashioned to deliver tiny doses of medications into the respiratory tracts directly, thereby keeping the systemic side-effects of the medications to the minimum potential. There are many types of asthma inhalators on the marketplace these days, the most popular being Ventolin.

Although bronchial asthma has similar symptoms to regular asthma when having a coughing and wheezing episode, this does not mean they are really having an asthma attack. As with normal asthma, everyday things like pet dandruff, household dust and interior mildew can trigger an episode of bronchial asthma. It is always best if you avoid these types of situation if you have trouble breathing when coming into contact with this type of situation. Nowadays, excellent face masks are easy to obtain for individual use if there is a situation where you will come into contact with a household pet that could

trigger he attack. people who struggle with bronchial asthma have severe problems when trying to run or even when they are under great stress.

Frequently certain foods might be the trigger and cause a mucus increase that leads to a bronchial attack, usually dairy products, these should be avoided if possible. Food like milk, bananas, ice cream and other cold food from the refrigerator can often be the things that exacerbate the condition. If you are unsure what activates your bronchial asthma you should rule out food products one at a time until you discover the culprits. Your asthma inhalator should be with you at all times in the event of an attack but especially if any type of physical exercise is planned.

As there are many ways to help your bronchial asthma condition, you shouldn't have to live in fear of it because it can be beaten but this necessitates patience and discipline on your part to pursue easy but good guidelines. Over time you should see an improvement in your condition which may be because your body adjusts during your life. If you ensure you carry established medication with you wherever you go, you will feel more confident and be less likely to have an episode if you have an asthma inhalator or pills in your pocket or bag.Pathophysiology: (to include precipitating/ predisposing factors and integration of the signs and symptoms)

The development of bronchial asthma is a multicausal process, which is caused by exogenic factors (environmental factors), and also by genetic dispositions. In addition, the course of the disease can be influenced by climatic changes and mental factors. Important exogenic activators are: Allergens o Environmental allergens (house dust mites, pollen) or Allergenic work substances (flour) or Food allergens , toxins or chemical irritants, respiratory diseases, pseudoallergic reactions (PAR) to analgesics (analgesic-induced asthma), physical exertion (mainly in children) patients with allergic asthma or other atopical diseases show a polygenic inherited trait for an overshooting immune response of IgE. If both parents suffer from atopy, the children have an atopical disease as well in 40-50% of the cases.

A number of factors can contribute to an asthmatic attack, including allergens, respiratory tract infections, hyperventilation, cold air, exercise, drugs, and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.

Inhalation of allergens is a common cause of asthma. Usually this type of asthma has its onset in childhood or adolescence and is seen in persons with a family history of atopic allergy. Persons with allergic asthma often have other allergic diosorders, such as hay fever, hives, eczema. Attacks are related to exposure to specific allergens. Among airborne allergens implicated in perennial (year round) asthma are house dust mite allergens, cockroach allergens, animal danders, and the fungus alternaria.

With bronchial asthma, you may have one or more of the following signs and symptoms:

Shortness of breath Tightness of chest Wheezing

Excessive coughing or a cough that keeps you awake at night

PREDISPOSING FACTORS PRECIPITATING FACTORS

HOST FACTORS:

Genetic predisposition Atopy or allergy Airway hyperresponsiveness Gender Race/ Ethnicity

ENVIRONMENTAL FACTORS: Indoor allergens Outdoor allergens Air pollution Respiratory infections Parasitic infections Socioeconomic factors Family size Diet and Drugs

Asthma is a chronic disease. It is an inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation causes an associated increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in early morning.

The three components which make up the composite course of action in pathophysiology of bronchial asthma are: airway inflammation, bronchial hyper-responsiveness and intermittent airflow impediment.

Airway inflammation is caused due to some specific reasons. And these reasons are a good indicator to whether the asthma is sub-acute, acute or chronic. Some of the other indicators that assist the diagnosis are the over secretion of mucus, bronchial reactivity and edema in the air passage: all of which result in obstruction of the sir flow. Further investigation may reveal permeation of eosnophils in varying degrees, damage of epithelium and mucus hyper-secretion.

Active T lymphocytes, mast cells, epithelial cells eosnophils and macrophages etc. can be seen as the reason for airway inflammation in pathophysiology of bronchial asthma. An examination of epithelial cells, fibroblasts and other air passage cells will show the severity of the asthma.

Another symptom in pathophysiology of bronchial asthma is the bronchial hyper activity or hyper-responsiveness to external stimuli. This is measured by causing direct stimulation of the smooth muscle of the airway as well as through indirect stimulation with substances from mast cells or other mediator-secreting cells. The results that are read from the hyper-responsiveness would give the level (severity) of the asthma.

The airflow obstruction is another approach in pathophysiology of bronchial asthma to evaluate the seriousness of asthma. Obstruction in the airway could be due to a series of reasons among which could be the edema of the airway, remodeling of the airway, the formation of a stubborn mucous plug in the airway, acute constriction of the bronchi, etc. The first asthmatic response, as per the pathophysiology of bronchial asthma is the acute bronchi-constriction as a reaction to a mediator release which happens when someone comes into contact with an allergen.

Airway edema follows the process with a minimum and maximum gap of 6 to 24 hours. The mucus plug formation, which is the third component, needs some weeks to

grow and disappear. If no other mode of reversing the obstruction formed in the airway is found the airway remodeling has to be done, which is the last component.