Asthma respiratory disorder

2. DEFINITION
Asthma is a non-communicable chronic lung disease, characterized by
the following features:
• Airway inflammation
• Airway obstruction mainly due to muscle spasm
• Mucosal edema due to the hyper-reactivity to aerobiological irritants.

4. ETIOLOGY
1. Host factors:
• Genetic: Genes predisposing to airway hyper responsiveness
• Sex: More in males, 2:1
• Psychosocial factors: Anxiety, Stress
• Weakened immune system, illness
• Exercise

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2. Environmental factors:
• Allergens: Domestic mites, animals dander, fungi, Pollens, yeasts.
• Infections: Predominantly viral in 40% of children.
• Climate: Seasonal variation (winter) of asthma attacks is experienced by
35% of children.
• Diet: certain foods also trigger it (peanuts, eggs, wheat, shellfish).
• Pollutants: tobacco smoke, mosquito coil smoke, sprays, perfumes etc.
• Drugs: aspirin, beta blockers.

7. TYPES
1. Based on duration
• Intermittent: asthma comes and goes, so the person feels normal in
between asthma flares.
• Persistent: symptoms are present much of the time with varying of
intensity (mild, moderate, severe).
2. Based on etiology
• Allergic: when allergens cause asthma (mites, pollen, dust)
• Nonallergic: asthma due to outside factors like stress, exercise, illness,
weather.
3. Based on age
• Adult onset: starts after the age of 18 years.
• Childhood: begins before the age of 5, mostly in infants and toddler

8. PATHOPHYSIOLOGY

10. CLINICAL MANIFESTATIONS
1. The classical manifestations are:
• Dyspnea, wheezing & cough.
• The episode of asthma usually begins with the child feeling
irritable & increasingly restless.
• Nocturnal Cough/Breathlessness.
• Others complain headache, feeling tired & chest tightness.

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2. Respiratory symptoms:
• Recurrent cough
• Post-tussive vomiting (vomiting after a bout of coughing) occurs in 5%
of cases.
• Abdominal pain: due to over-working of expiratory abdominal muscles.
• Chest pain is present rarely.
• Other comorbid conditions like allergic rhinitis, sinusitis, otitis media,
eczema etc.
• Shortness of breath, prolonged expiration, wheezy chest, cyanosis.

12. DIAGNOSTIC EVALUATIONS
1. History taking (Ask)
• Has the child had an attack or recurrent episode of wheezing?
• Does the child have a troublesome cough which is particularly worse at
night?
• Is the child awakened by coughing or difficult breathing?
• Does the child cough or wheeze after physical activity (like games and
exercise) or excessive crying?
• Does the child experience breathing problems during a particular season?

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2. Physical Examination (Look).
• Dyspnea, Expiratory wheeze, Accessory muscle movement,
• Difficulty in feeding, talking, getting to sleep
• Irritability to Cough
• Eczema, Allergic Rhinitis
3. Chest x ray: Chest X-ray is not needed to diagnose asthma. It is needed
only when the diagnosis is not clear or any complications are suspected.

15. MEDICAL MANAGEMENT
1. Oxygen: Give oxygen to keep oxygen saturation > 95% in all.
2. Pharmacotherapy:
• Quick relievers: Used for acute attacks to relieve bronchospasm when
needed. E.g. Salbutamol, Terbutaline, Adrenaline, Aminophylline
• Preventers/long term control medicines: Used to control the
inflammation and to prevent further attacks.
- Steroids (Oral and Inhaled) like prednisolone.
- Bronchodilator :Theophylline, magnesium sulfate (severe asthma)

16. NURSING MANAGEMENT
The management of asthma includes:
• Education
• Environment control
• Evaluation
• Emotional support
• Regular follow-up.

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1. Education: Clear the misconceptions about the disease, sexual bias, non-
communicability of the disease, fear of inhalers, steroids etc.
2. Environment Control: The aim should be to avoid allergens and irritants:
• Dust mites: Avoid carpets, use plastic covers to pillows and mattresses;
and expose to sunlight once a week; wash soft toys periodically; and wet
mop the floorings.
• Cockroach: Cover garbage and unused food containers.
• Fungus: Attend to damp walls, have good ventilation and clean the shower
curtains weekly.
• Pets: Keep them away from sleeping area, if possible outside the house.
• Avoid strong odors, smoke, mosquito coil burning, and especially tobacco
smoke.

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3. Evaluation
• Frequent assessment of respiratory pattern.
• Cyanosis
• Breath sounds
• Vital signs
• Cerebral functions

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4. Providing emotional support:
• Calm and quiet approach
• Trusting relationship
• Reassurance
• Play and recreation
• Parental participations
5. Positioning:- Comfortable sitting position and supporting with pillow.

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6. Administering fluid therapy:
• During asthma they take less fluid.
• Vomiting and insensible loss due to hyperventilation.
• Clear liquids in small amounts.
• Intravenous fluid administration
• Maintain input output chart
7. Maintaining adequate dietary intake:
• Allergic foods to be avoided.
• Spicy and gas forming foods to be avoided.
• Balanced diet in small amount and frequent interval.

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8. Maintenance of hygienic measures
• Routine hygiene care.
• Aseptic technique.
9. Supporting parents and family
• Emotional support
• Parent participation in care
• Discuss treatment plan.
10. Follow-up care

22. COMPLICATIONS
• Pneumonia
• Respiratory failure