BRONCHIAL ASTHMA

Bronchial Asthma Is a chronic reactive airway dxr that produces airway obstruction resulting from bronchospasm,increased mucous secretion, mucosal oedema and airway inflammation. 

OR 

Bronchial Asthma is a reversible airway disease characterized by episode of reversible Airways obstruction, bronchial spasm, excessive mucous secretion and oedema. 

Note: It is a common dxr of childhood that may continue to cause problems 2ruout adult life.

Types:

👠EXTRINSIC(ATOPIC):results from specific external allergens.e.g. dust and pollen. 

👠INTRINSIC  (NON-ATOPIC):results from internal non-allergic factors.e.g. Infection. 

👠MIXED ASTHMA:This is a combi of the previous two.

👠DRUG-INDUCED ASTHMA:This is caused by continuous and long term use of drugs.e.g. Aspirin and related compounds (NSAIDS).

👠EXERCISE-INDUCED ASTHMA:Is caused by vigorous activity. E.g. 5-20mins of sustained exercise. 

👠OCCUPATIONAL ASTHMA:Caused by inhalation of industrial fumes,gases,dust,and allergens.

Causes/predisposingfactors/Risk factors:

⚠Familial tendency  (hereditary )

⚠Paediatric implications 

⚠Environmental stimuli.e.g.air pollution, gases,dust,pollen, fumes, dandruff'feather pillow.

⚠Infection especially RTI,ALlergic rhinitis.

⚠Emotional stress

⚠Fatigue

⚠Endocrine changes

⚠Temperature and humidity variations

⚠Exercise(physical activities )

⚠Smoking.

Pathophysiology:

👉Any of the above causes (.e.g.inhaling fumes) would lead to arousal of the immune system (hypersensitivity) by abnormal antibodies which stimulate the mast cells in the mucous membrane of the respiratory tract.

👉The mast cells release histamine, bradykinin,and PGs (vaso-active mediators )which lead to BRONCHOSPASM and excessive mucus secretion by the membrane.

👉This bronchospasm leads to narrowing of the airway,leading to WHEEZING RESPIRATION and INHALATION IS EASY but EXPIRATION IS DIFFICULT. 

👉Irritation of the mucus membrane leads to COUGH which may or may not be productive at the initial stage.

👉Mucus fills the base of the lungs inhibiting alveolar ventilation thereby,impairing gas exchange.

👉If not promptly managed,HYPOXIA occurs which is manifested in BLUISH Discoloration (CYANOSIS), PROFUSE SWEATING(DIAPHORESIS) and RESTLESSNESS.

Clinical manifestation :

✏Wheezing respiration 

✏Cough

✏Chest tightness

✏Hypoxia

✏Dyspnea

✏Respiratory distress 

✏Restlessness 

✏Weak pulse

✏Restlessness 

✏Profused sweating 

✏Expiration more strenuous and prolonged than inspiration

 Diagnostic Evaluation :

🌟Pulmonary function studies(to reveal signs and symptoms of airway obstruction and decreased Spo2.

🌟Increased serum IgE levels in allergic rxn. 

🌟Increased eosinophil count in the blood.

🌟Chest X-ray(May show hyperinflation with areas of atelectasis)

🌟Skin test(To identity specific allergens)

🌟ABG analysis(To detect hypoxemia).

MGT:

✏✏NOTE!!!!

The best mgt/txt for asthma is prevention by identifying and avoiding ppt factors such as environmental allergens or irritants. 

Usually,such stimuli can't be totally removed..so DESENSITIZATION to specific antigens may be helpful especially in children.

 Other common mgt therapy include;

✔MEDICATION(DRUGS)

💊Bronchodilators: to relax the bronchial smooth muscles.e.g. Aminophylline and theophylline.

💊Expectorants, mucolytic and antitussive agents(facilitate expulsion of mucus).

💊Corticosteroids :combat sever immune or inflammatory responses,thereby making the airway patent.e.g. Hydrocortisone, methylprednisolone and Dexa.

💊Mast cell inhibitors or stabilizers:They inhibit mast cells,thereby resulting in Bronchodilation and decreasing airway inflammation.e.g. Cromolyn sodium.

💊Adrenergics (Sympathomimetics):They dilate bronchial smooth muscles to relieve bronchospasm. E.g. Ephedrine

💊Antibiotics :Used if infection is present,to combat pathogenic microbes.e.g. Amoxicillin,Penicillin,Erythromycin and Tetracycline.

✔OXYGEN THERAPY

Low-flow humidified oxygen may be needed to relieve dyspnoea, cyanosis, hypoxemia and to maintain PO2.

Nursing Mgt:

During an acute asthma attack include the ffg

🐒Stay with the pt and keep him/her calm and in an upright position. 

🐒Encourage relaxation technique and purse-lip breathing. 

🐒Administer oxygen as prescribed and if there is obstruction of the airway by secretions, suction the airway to make it patent before administering the O2.

🐒Encourage deep breathing and coughing exercises to clear airway.

🐒Implement measures to pulmonary asthmatic attacks such as:

🏈Minimize exposure to pulmonary irritants.

🏈Keep the homes as dust free as possible. 

🏈Use an inhaler and take medications as prescribed.

🏈Encourage client to always be with his/her inhaler anytime,any day. 

🏈Notify the health care provider when a respiratory infection occurs.

Nursing Diagnoses:

💉Ineffective airway clearance rt bronchospasm/excessive mucous secretion eb wheezing respiration. 

💉Impaired breathing pattern rt respiratory obstruction/obstruction of airway eb Dyspnea. 

💉Impaired gas exchange related to alveoli occlusion eb bluish coloration of skin (cyanosis).

💉Anxiety rt tightness of the chest/unknown outcome of disease eb restlessness and diaphoresis respectively(choose one).

COMPLICATIONS 

⚠Status Asthmaticus

⚠Heart failure

⚠Shock 

⚠Coma.