This document provides information about asthma, including its definition, prevalence, pathophysiology, clinical manifestations, diagnostic studies, management, and nursing considerations. Asthma is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms of wheezing, breathlessness, chest tightness, and cough. It affects over 300 million people globally. Management involves both long-term control medications and quick-relief medications. The goals of nursing management are to stabilize respiratory status, relieve symptoms, reduce anxiety, promote health, prevent complications, and prevent further asthma episodes.

1. ASTHMA
PRENTOR:
K.UDAYASREE
TUTOR
APOLLO COLLEGE OF NURSING.
CHITTOOR.

2. INTRODUCTION
• Asthma is a long-term inflammatory disease of
the airways of lungs. It is characterized by variable
and recurring symptoms, reversible airflow
obstruction, and easily triggered bronchospasms.
• Asthmatic episodes may occurs few times a day or a
few times per week. Depending on the person,
asthma symptoms may become worse at night or
with exercise

3. DEFINITON
• Asthma is a reversible chronic inflammatory airway
disease which is characterized by bronchial hyper
responsiveness of the airways to various stimuli,
leading to widespread bronchoconstriction, airflow
limitation and inflammation of the bronchi causing
symptoms of cough, wheeze, chest tightness and
dyspnoea.

5. PREVALENCE
• It was estimated that more than 339 million people
had Asthma globally in 2016.
• Among India’s 1.31 billion people, about 6% of
children and 2% of adults have asthma.
• Among adults women have a 30% greater
prevalence of asthma than men.
• Most asthma-related deaths occur in low- and lower-
middle income countries.

6. TRIGGERING FACTORS

8. PATHOPHYSIOLOGY
Early-Phase Response
–Peaks 30-60 minutes post exposure, subsides
30-90 minutes later
– Characterized primarily by bronchospasm
–Increased mucous secretion, edema formation,
and increased amounts of tenacious sputum
–Patient experiences wheezing, cough, chest
tightness, and dyspnea

9. PATHOPHYSIOLOGY
Late-Phase Response
• Characterized primarily by inflammation
• Histamine and other mediators set up a self-
sustaining cycle increasing airway reactivity
causing hyperresponsiveness to allergens and
other stimuli
• Increased airway resistance leads to air trapping
in alveoli and hyperinflation of the lungs
• If airway inflammation is not treated or does not
resolve, may lead to irreversible lung damage

11. CLINICAL MANIFESTATIONS
• Recurrent episodes of wheezing, breathlessness,
cough, and tight chest
• Secretions may be white, thick, tenacious,
gelatinous mucus.
• Expiration may be prolonged
from a inspiration-expiration
ratio of 1:2 to 1:3 or 1:4
• Use of external respiratory
muscles.
• Nasal flaring.

12. CLINICAL MANIFESTATIONS
• Wheezing is an unreliable sign to gauge severity
of attack
• Severe attacks can have no audible wheezing
due to reduction in airflow
• Difficulty with air movement can create a feeling
of suffocation
–Patient may feel increasingly anxious
–Mobilizing secretions may become difficult
• Between attacks may be asymptomatic with
normal or near-normal lung function

13. TYPES OF ASTHMA
• ALLERGIC ASTHMA (extrinsic asthma):
Hyper immune response to the inhalation of specific
allergen.
• NON-ALLERGGIC ASTHMA (Intrinsic asthma) :
Triggered by the presence of irritants in the air that
are not related to allergies. stimulate
parasympathetic nerve fibers in the airways causing
broncho-constriction and inflammation.
• MIXED ASTHMA:
Mixed asthma is the combination of both allergic and
non-allergic asthma. This is the most common form
of asthma.

14. COMPLICATIONS
• Atelectasis
• Bronchitis
• Pneumothorax
• Pneumonia
• Respiratory failure

15. DIAGNOSTIC STUDIES
• History of Presenting symptoms
• Cough sputum –
 time: become worse at night
 duration: chronic / acute
 associated with wheezing
 fever? URTI
• Wheeze
 max during expiration

16. • Dyspnoea History
onset: after exercise? cold? dust? animal fur?
emotion?
severity and pattern: varies from day to day or
from hour to hour
no chest pain
• History of Clinical features:
 Recurrent episodes of Wheezing, chest
tightness, breathlessness and cough
 Precipitants- cold, allergen, pollutant,
 Exercise tolerance
 Disturbed sleep

17. • Past medical history
Experienced asthma attack before
Taking any medications: NSAIDs / β-blocker /
aspirin (non atopic asthma)
• Family history:
Any family history of asthma present
• Social history:
Occupation: expose to fumes/organic/chemical
dust
House: near to factory? Pets? Dust? Carpet?
Feather pillow?
Smoking in any family members

18. Phsyical examination
• General inspection:
 Tachypnoeic,
 sign of respiratory distress,
 effort of breathing,
 cyanosis (life-threatening)
• Inspection:
 fingers: tar staining
 used of accessory muscles or recession
 wheezing

19. • Chest
Inspection:- shape: hyperinflated in severe asthma-
movement of chest/silent chest (life-threatening)- chest
deformity- recession.
Palpation:
- chest expansion may be reduce / normal
- apex beat: may be displaced -vocal fremitus: decrease
Percussion:
may be hyper resonance / normal
Auscultation: breath sound: vesicular
- rhonchi in expiratory phase, may be both in severe
asthma
- prolonged expiratory phase
-vocal resonance decrease / normal

20. OTHER DIAGNOSTIC STUDIES
• PFT: ↓sed FVC, FEV, PERF.
• Peak expiratory flow rate: presence of
obstruction.
• Chest X-ray: lung hyper inflation.
• ABG or oximetry decreased spo2
• Allergy skin testing.
• Blood level of eosinophil and IgE are usually
elevated suggestive of atopy (allergic tendency)

22. MANAGEMENT
GOALS:
 Achieve and maintain control of symptoms
 Maintain normal activity levels, including exercise
 Maintain pulmonary function as close to normal
levels as possible
 Prevent asthma exacerbations
 Avoid adverse effects from asthma medications
 Prevent asthma mortality

23. MEDICAL MANAGEMENT
• Long-term control medications
–Achieve and maintain control of persistent
asthma
• Quick-relief medications
–Treat symptoms of exacerbations

24. • Bronchodilators
–-adrenergic agonists
(e.g., albuterol, salbutamol[Ventolin])
•Acts in minutes, lasts 4 to 8 hours
•Short-term relief of bronchoconstriction
•Treatment of choice in acute exacerbations
•Useful in preventing bronchospasm
precipitated by exercise and other stimuli
•Overuse may cause rebound bronchospasm
•Too frequent use indicates poor asthma
control and may mask severity

25. Antiinflammatory drugs
–Corticosteroids (e.g., beclomethasone,
budesonide)
•Suppress inflammatory response, inhibit
release of mediators from macrophages and
eosinophils
•Inhaled form is used in long-term control
•Do not block immediate response to
allergens, irritants, or exercise
•Do block late-phase response to subsequent
bronchial hyperresponsiveness

26. –Mast cell stabilizers (e.g., cromolyn, nedocromil)
• Inhibit release of histamine
• Inhibit late-phase response
• Long-term administration can prevent and
reduce bronchial hyper-reactivity
• Effective in exercise-induced asthma when used
10 to 20 minutes before exercise
–Leukotriene modifiers (e.g. Singulair)
• Leukotriene – potent bronchco-constrictors and
may cause airway edema and inflammation
• Have broncho-dilator and anti-inflammatory
effects

27. HOW TO USE INHALARS

28. COLABERATIVE THERAPY
• Education
• Reducing Exposure to Environmental Tobacco
Smoke
• Reducing Exposure to allergens (House Dust, Mites,
pets , pollens etc.,)
• Perform regular exercise: Asthma should not usually
prevent you from exercising if you:
 Keep your asthma under control
 Warm-up before and cool-down after exercise
 Take a “reliever” medicine 5–10 minutes before
exercising, if needed

29. • Self-management
- Emphasis on evaluating outcome in terms of
patient’s perceptions of improvement
• Acute Asthma Episode
–O2 therapy should be started and monitored
with pulse oximetry or ABGs in severe cases
–Inhaled -adrenergic agonists by metered dose
using a spacer or nebulizer
–Corticosteroids indicated if initial response is
insufficient

30. Status asthmaticus
–Most therapeutic measures are the same as for
acute
–Increased frequency & dose of bronchodilators
–Continuous -adrenergic agonist nebulizer
therapy may be given
–IV corticosteroids
–Continuous monitoring
–Supplemental O2 to achieve values of 90%
–IV fluids are given due to insensible loss of
fluids
–Mechanical ventilation is required if there is no
response to treatment

31. NURSING MANAGEMENT
GOAL:
 To stabilize the respiratory status and relieve
symptoms
 To reduce anxiety
 To promote health
 To prevent complications
 To prevent further asthmatic episodes.

32. To stabilize the respiratory status and relieve
symptoms
–Monitor respiratory and cardiovascular systems
•Lung sounds
•Respiratory rate, pulse, BP, ABGs
•Pulse oximetry
•Administer O2
•Chest physiotherapy
•Breathing exercises
•Medications (as ordered)
•Ongoing patient monitoring

33. TO REDUCE ANXIETY
An important goal of nursing is to decrease the
patient’s sense of panic
–Stay with patient
–Encourage slow breathing using pursed lips for
prolonged expiration
–Position comfortably

34. HEALTH PROMOTION
• Fluid intake of 2 to 3L every day
• Adequate nutrition
• Adequate sleep
• Take -adrenergic agonist 10 to 20 minutes prior
to exercising
• Counseling may be indicated to resolve problems
• Relaxation therapies may help relax respiratory
muscles and decrease respiratory rate

35. • Important patient teaching:
–Seek medical attention for bronchospasm or
when severe side effects occur
–Exercise within limits of tolerance
–Patient must learn to measure their peak flow
at least daily
–Asthmatics frequently do not perceive changes
in their breathing

36. PREVENT COMPLICATIONS AND
FURTHER EPISODES
–Teach patient to identify and avoid known
triggers
•Use dust covers
•Use of scarves or masks for cold air
•Avoid aspirin or NSAIDs
–Desensitization can decrease sensitivity to
allergens
–Prompt diagnosis and treatment of upper
respiratory infections and sinusitis may prevent
exacerbation

37. NURSING DIAGNOSIS
• Ineffective airway clearance related to expiratory
airflow obstruction, ineffective cough, decreased
airway humidity and infection in airway as
evidenced by absence or decreased breath
sound.
• Imbalanced nutrition less than body requirement
related to poor appetite, lowered energy level,
shortness of breath as evidenced by weight loss.

38. NURSING DIAGNOSIS
• Disturbed sleeping pattern related to anxiety,
dyspnoea as evidenced by frequent awakening,
prolonged onset of sleep, lethargy, fatigue,
irritability.
• Risk for infection related to decreased pulmonary
function, possible corticosteroid therapy and lack
of knowledge regarding signs and symptoms of
infection and preventive measures.