ASTHMA

                                                                        ASTHMA

What is Asthma ?

Asthma is a lower respiratory tract pulmonary obstructive disease which is also called as "Reactive Airway Disease".

Definition :

Asthma is the chronic inflammatory disease of the airways characterized by variable & recurring symptoms & bronchospasm.

Pathophysiology :

Allergens are responsible for obstruction of airways by either inflammation of airway lining or constriction of bronchial smooth muscles due to activation of mast cells & histamine in immune system charecterized by mucus secretion & episodes of bronchospasm.

Etiology & risk factors :

• Heridatory
• Environemntal triggers
• Allergens
• Air pollution 
• Upper respiratory tract infections
• Occupational factors Psychological factors
• Idiopathic

Types :

• Extrinsic asthma : Also called as Atopic  asthma caused by allergens such as pollens, animal dander, dust. Often accompanied by allergic rhinitis O eczema & is usually heridatory.
• Intrinsic Asthma : Also known as non- atopic, caused by non allergic factors such as respiratory tract infections, exposure to cold air, changes in air humidity or respiratory irritants.

Sign & Symptoms :

• Wheezing
• Shortness of breath
• Dyspnea
• Tachypnea = RR> 20 breaths/min
• Chest tightness
• Cough
• Tachycardia HR> 100 beats/min
• Hypoxia
• Cyanosis
• Anxiety

Medical & Nursing Management:

• Short acting beta adrenergic blockers for bronchodilation : Terbutaline, Albuterol, Levalbuterol
• Long acting beta adrenergic blockers for bronchodilation : Salmetrol, Formetrol
• Leukotrin modulators to reduce inflammatory response in lungs & to reduce exacerbations : Zafirlukast, Montelukast
• Anticholinergic Drugs
• Ipatropium inhaler or Tiotropium HandiHaler
• Antacids, PPIs : ranitidine, pantoprazole
• Mast cell stabilizers : Cromolyn, Nedocromil
• Steroids : Hydrocortisone, Methylprednisolone IV
• Omalizumab subcutaneously
• Fowler's position to patient
• Explain patient about use of inhaler
• Encourage deep breathing & coughing exercise
• Vital signs to be monitored
• Avoid exposure of allergens
• Nebulization

 

Distinctive facts :

• Ix- ABG analysis, CXR, PFT, CBC, Sputum analysis
• "Silent chest " important feature of asthma.
• Metered dose inhalers in combination with asthma spacer & dry powder inhaler
• Complications include : Status Asthmaticus

 Prognosis :

• Avoiding triggers reduces the level of incidence.
• Proper use of inhalers can improve the prognosis
• Patient who do not use medications properly may die during asthma attack