SEMINAR ON

ASTHMA
PRESENTED BY:
LUMINA.S
M.SC (N)
 DEFINITON

Bronchial asthma is a chronic inflammatory disorder of the

airway characterized by an increased responsiveness of the
airways to various stimuli. It manifests by wide spread
narrowing of the airway causing paroxysmal dyspnea,
wheezing or cough
 CLASSIFICATION OF ASTHMA
Based on duration
 Intermittent
 Mild
 Moderate
 Severe
Based on etiology
 Atopic
 Non atopic
 Mixed
 Exercise induced or aspirin induced
ETIOLOGY:
 outdoors
 Irritants
 Exposure to occupational chemicals
 Environmental changes
 Colds and infection
 Animals
 Medications
 Strong emotions
 Disease conditions
 Food additives
 Biochemical causes
 Genetic and immunological causes
 Psychological factors
 smoking
TRIGGERS OF ASTHAMA
 Inhalant allergens
 Foods
 Viruses or infections
 Cold air
 Tobacco smoke
 Pollution
 Exercise
 Family history of asthma
 Smoking parents
 Lack of exclusive breast feeing
 Early weaning before 4 months
 Born and living in the slum area
 Living in the flat
 Inadequate ventilation
PATHOPHYSIOLOGY
CLINICAL FEATURES:
 Cough – hacking, paroxysmal, irritative and non productive
 Become rattling and productive of frothy, clear gelatinous
sputum
 Respiratory related – shortness of breath
 Prolonged expiratory place
 Audible wheeze
 lips deep, dark red color
 Restlessness
 Apprehension
 Prominent attack as the attack progress
 speaking with short, panting, broken phrases
 Sitting upright position is good
CHEST:
 Hyper resonance on percussion
 Coarse, loud breath sounds
 Wheeze through out the lung field
 Prolonged expiration
 Crackles
 Generalized inspiratory and expiratory wheeze
 Barrel chest
 Elevated shoulders
 Use of accessory muscle for respiration
 Facial features – flattened malar bone
 Circle beneath the eye
 Narrow nose and prominent teeth
DIAGNOSIS:
 Absolute eosinophils test
 Chest X – ray film
 RAST allergy test (Radioallergosorbent)
 Bronchial challenge test
 Exercise tolerance test
 Cytologic examination of sputum
 Serum test
 Total Ig E immediate type skin test
 Pulmonary function test
 Green – (80% - 100%) signals clear
 Yellow – ( 50% - 79% ) signals caution
 Red – ( < 50% of test) signals a medical allert
 TREATMENT FOR ASTHMA

Medical

Nursing Pharma
manage cologic
ment al

Chest Hypo
physiot sensitiz
herapy ation
MEDICAL MANAGEMENT:
 Assessment of severity of asthma
 Selection of medication
 Selection of appropriate inhalation device
 Monitoring
ASSESSMENT OF SEVERITY:
 Step 1 : intermittent asthma – symptoms < 2 days / week
• Night time symptoms none /> 2 times a month
• PEF / FEV1≥ 80%, interference with normal activity - none
 Step 2 : mild persistent asthma – symptoms > 2 times a week,
but < 1 time a day
• Night time symptoms – 1 – 2 times a month≥ 80% of
predicted value
• Interference with normal activity is limited
Step 3 or 4 : moderate persistent asthma
• Daily symptoms
• Night time symptoms 3 – 4 times a month > 1/week
• PEF 60% - 80% predicted value, interference with normal
activity - some limited
 Step 5 – 6 : severe persistent asthma:
• Continual symptoms through out the day
• Frequent night time symptoms
• PEF <60%
• FEV < 75%
• Interference with normal activity is extremely limited
SELECTION OF MEDICATION:
 Intermittent: short acting beta agonist
 Mild persistent: short acting +beclomethasone or cromolyn
sodium/sustained relief theophillin/leukotriene modifiers
 Moderate persistent: short acting beta agonist+ inhaled
budesonide, fluticosone/ beclomethasone. If needed
salmeterol
 Severe persistent asthma: as same +salmeterol/ formeterol or
sustained release theophiline+ oral lowdse prednisolon on
alternative days.
SELECTION OF DEVICE:
 Metered dose inhaler
 Metered dose inhaler with spacer
 Metered dose inhaler with spacer with face mask
 Dry powder inhaler
 nebulizer
MONITORING:
 Patient should seen by physician every 4 – 12 weeks
 On each visit detailed history should be obtained
 On each visit physician should examine the child
 Look for drug side effects
 Pulmonary function test / PEFR should be measured
PHARMACO THERAPY:
 Broncho dilators
 Cortico steroids
 Mast cell stabilizers
 Leukoterien modifiers
 Immunotherapy
 Theophylline
HYPO SENSITIZATION: (ALLERGEN IMMUNO THERAPY)
 Subcutaneous immunotherapy
 Sublingual immunotherapy
 Anti IgE therapy: omalizumab
 Anti interleukin – 13 therapy: lebrikezumab
 Bronchial thermoplasty
 Treating airway hyper responsiveness:
 Thromboxane A2 receptors – seratrodust
 Long acting beta 2 adrenoreceptors – indacaterol
 Phospho diesterase – 4 – inhibitors : roflumilast
COMPLEMENTARY THERAPIES:
some 9 opinion in CAM:
• Massage or other manipulative technique
• Herbal treatment
• Acupuncture
• Homeopathy
• Breathing exercise
• Vitamin or other supplements
• Chiropractic
• Dieting programmes
• Naturopathy
CHEST PHYSIOTHERAPY
NURSING MANAGEMENT:
• Avoid allergens
• Relieve bronchospasm
• Environmental control
• Provide acute asthmatic care
• Support the child or adolescent and family
• Health education
NURSING DIAGNSIS:
 Ineffective airway clearance related to excessive secretions
 Impaired breathing pattern related to constriction of airway
 Acute pain related to increased breathing activity/using
accessory muscles
 Imbalance nutrition less than body requirement related to
increased energy needs
 Activity intolerance related to fatigue
 Anxiety related to disease condition
 Risk for fluid and electrolyte imbalance related to fluid loss