C.H.

D
Non-Communicable Diseases

ASTHMA
 ASTHMA
-Intermittent, irreversible airway obstruction

-It’s onset is sudden as opposed to the slow insidious

progression of symptoms seen in bronchitis and
emphysema

-Increase responsiveness if trachea and bronchi to

various stimuli
 ASTHMA
-is a common chronic inflammatory disease of
the airways characterized by variable and recurring
symptoms, airflow obstruction, and bronchospasm.
 Manifestations
 Dyspnea

 Cough

Sputum

Chest Pain

History on cigarette smoking

 wheezing
 Risk Factors
Environmental Factors (change in temperature)

Atmospheric Pollutants (industrial and cigarette smoke)

Stress and Emotional 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
 Pathophysiology
 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
 Pathophysiology
Increased airway resistance

Results from muscle spasm, mucosal inflammation and hyper secretion

of mucus

Altered Oxygen and Carbon Dioxide Exchange

Increased airway resistance and hyperinflation that cause respiratory

muscles to work harder resulting in muscle fatigue and ultimately
exhaustion.
 Management and Treatment

Primary goal of treatment: To

promote normal functioning of the
individual, prevent recurrent
symptoms, prevent severe attacks
and prevent side effects from
medications
 Management and Treatment

Pharmacological:

→Inhaled B-agonist (albuterol sulfate, ventalin)

it stimulates b2 receptors in bronchial smooth muscle resulting in
relaxation

→Methylprendnisolone
reduces inflammation and edema of airway and decreases
hyperactivity of airway

→Bronchodilators(ephinephrine, ephedrine)
 Management and Treatment

Complications:
•Spasms of the
extremities

•Tachycardia

•Headache
 Diagnostic
Evaluation
A clear history of hypersensitivity to some known substance that may be inhaled
or ingested-particular type of food, feathers, animal hair, face powder, or such a
history suggesting the probability of such sensitivity.

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.

Finding of an abnormally high count of eosinophilic cells in the blood or the

sputum tends to confirm this diagnostic impression.

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

Testing in Pulmonary function laboratory can usually provide

objective evidence of airway obstruction.

Often a diagnosis is confirmed by instructing the patient to inhale a

trial aerosol bronchodilator (during a coughing episode)
 Nursing
Intervention
Improving Airway Clearance:

1. Ensure adequate systemic fluid intake

2. Provide adequate nutritional levels

3. Provide extra humidity

4. Medicate with bronchodilators

5. Teach effective cough maneuver

 Nursing
Intervention
Providing Emotional Support and Preventing Anxiety

1. Never leave patient alone during an asthmatic attack

2. Encourage relaxation techniques

3. Give/Assist the patient with respiratory maneuvers

4. Assess for possible medication overuse

 Nursing
Intervention
Improving Breathing Patterns

Improving gas exchange

1. 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
SEVERITY OF
ASTHMA in
adults
 Mild Episode
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
 Moderate
Episode
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 3-4 hours for 24-28 hours. If
not improved in 2-6 hours after initial treatment, begin or increased
prednisone. Contact your physician
 Severe Episode
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.
THE END 