DEFINITION :

Bronchial asthma is a chronic inflammatory disease of the airways, associated with recurrent,
reversible airway obstruction
with intermittent episodes of wheezing and dyspnea. Bronchial
hypersensitivity is caused by various stimuli, which innervate the vagus
nerve and beta adrenergic receptor cells of the airways, leading to bronchial
smooth muscle constriction, hypersecretion of mucus, and mucosal edema.

Bronchial Asthma triggers may include:

• Tobacco smoke
• Infections such as colds, flu, or pneumonia
• Allergens such as food, pollen, mold, dust mites, and pet dander
• Exercise
• Air pollution and toxins
• Weather, especially extreme changes in temperature
• Drugs (such as aspirin, NSAID, and beta-blockers)
• Food additives (such as MSG)
• Emotional stress and anxiety
• Singing, laughing, or crying
• Smoking, perfumes, or sprays
• Acid reflux

These factors that contribute to trigger bronchial asthma causes “AIRWAY

INFLAMMATION”! HOW?
• The linings of our bronchi consists of 2 layers.
The first layer is the epithelial cells lining in which it is a hexagonal
shape cells that allows them to packed together.

When triggering factors invades the epithelial cell lining, your

oversensitive immune system activates antibodies such as IgE,mast
cells and WBCs’ to protect us from perceived threats.

But the result is actually inflammed airways causing an increased

mucus production between compartments of epithelial cell linings, thus
resulting to mucus producing goblet cells.

This mucus producing goblet cells will now flow to the second layer of
the bronchi which is the brochial smooth muscle, triggering the release
of cytokines and eventually causing bronchospasm and symptoms of
bronchial asthma that make it harder for us to breathe.
WHAT WILL HAPPEN TO THE LINING OF YOUR BRONCHI AFTER AN AIRWAY
INFLAMMATION?
It will become edematous, epithelial cell linings becomes injured,
impaired mucociliary function, increased airway responsiveness and
airway limitation. This process will lead to “BRONCHIAL ASTHMA”.
If bronchial asthma was left untreated or being treated but with repeated
exposure to the triggering factors, COMPLICATIONS OCCUR:
These are the complications:
♥ Status asthmaticus
♥ Respiratory failure
♥ Pneumonia
♥ Atelectasis

CLINICAL MANIFESTATIONS:
The symptoms of
bronchial asthma includes:
• a feeling of tightness in the chest;
• difficulty in breathing or shortness of breath;
• wheezing; and
•
coughing (particularly at night).
Patient being treated but with repeated exposure to triggering factors,
“EXCACERBATIONS OCCUR”.
Signs & symptoms of excacerbations includes:
➢ Cough with or without mucus
Generalized wheezing (the sound of airflow through narrowedairways)
Generalized chest tightness
Dyspnea & Tachycardia
Expiration requires effort and becomes prolonged
Diaphoresis & fatigue
Widened pulse pressure
Hypoxemia & central cyanosis
Respiratory failure

DIAGNOSTIC TEST:
1.Hematology (Complete Blood
Count)
Reveals elevated levels of WBC
( eosinophils to rule out infection or
inflammation
2.Pulse oximetry
Reveals hypoxemia during acute
attack
3.Arterial Blood Gas
Reveals normal PaCO2 which is an
impending sign of respiratory distress
because CO2 level can never be
normal with brochial asthma
4. Spirometry
Provides a means for measuring:
✔ FVC (Forced vital capacity
✔ FEV 1.0 (Forced expiratory
volume in one second)
✔ PEV (Peak expiratory flow)

IRC (Inspiratory reservecapacity)

Tidal volume
✔ Expiratory reserve
5.Inhalation Challenge Test
Measures the level of airway
responsiveness using methacholine
(a cholinergic agonist), histamine or
exposure to non pharmacologic agent
such as cold air
6.Peak Flow Meter
Measures the highest volume of air
flow during a forced expiration
TREATMENT & MANAGEMENT:
The expert panel of the National Asthma Education and Prevention
Program (NAEPP) has developed measures to control triggering factors
contributing to bronchial asthma:
1.Education of the patient and family regarding measures used in
avoiding exposure to irritants and allergens that are known to induce
or trigger an attack.
2.Relaxation technique and controlled breathing often help to allay the
panic and anxiety that aggravate breathing difficulties.
3.Injection of selected antigen (based on skin test) to stimulate the
production of IgG antibodies that block the IgE response.
4.A course allergen immunotherapy is typically 3 to 5 years duration.
5.Pharmacologic treatment is used to prevent or treat reversible airway
obstruction and airway hyperresponsiveness caused by inflammatory
process:
Bronchodilators
Anti – inflammatory
2 General Categories
A. Quick Relief Medication (short – acting)
☺ Beta2 – adrenergic agonists – albuterol (salbutamol)
☺ Anti – cholinergic agents – Ipratropium
☺ Systemic cortocosteroids

B. Long Term Medication

☺ Anti – inflammatory agents – corticosteroids, sodium
cromolyn, nedocrom, salmeterol, formoterol and albuterol
sustained releasedLong acting bronchodilators – theophylline, methylxathine
☺ Leukotriene modifiers – zileuton, zafirlukast and
montelukastNURSING MANAGEMENT:
The nurse assesses the patient’s respiratory status by monitoring the
severity of symptoms, breath sounds, peak flow, pulse oximetry and vital
signs. The nurse generally performs the following tasks:
♂ Obtains a history of allergic reactions to medications before
administering medications
Identifies medications the patient is currently taking. Administers medications as prescribed
and monitors the patient’s
responses to those medications. An antibiotic may be prescribed if the
patient has an underlying respiratory infections.
♂ Adminiters fluids if the patient is dehydrated.

REFERENCES:
A.Reading Materials:
☼ 2007 Lippincott’s Nursing Drug Guide by Amy
M. Karch
☼ Brunner & Suddarth’s Textbook of Medical –
Surgical Nursing Eleventh Edition by Suzanne
C. Smeltzer, Brenda G. Bare, Janice L. Hinkle,Kerry H. Cheever
☼ Pathophysiology : Concepts of altered health
state Seventh Edition by Carol Mattson Porth
Nursing Care Plans : Nursing Diagnosis &
Intervention Sixth Edition by Gulanick and
Myers
☼ Nursing Diagnosis : Reference Manual Sixth
Edition by Sparks & Taylor