ASTHMA

Pathophysiology:

• Asthma is a chronic lung disease characterized by:

1. Airway inflammation.
2. Airway hyper responsiveness to various stimuli such as
a virus, allergen or exercise.
3. Airway obstruction or narrowing that is reversible, with
treatment or spontaneously.
• The underlying problem is inflammation as a result of complex
interactions among inflammatory cells, mediators and the
tissues in the airways.
• Stimuli activate the release of inflammatory mediators from
mast cells, macrophages, eusinophils and other cells in the
airways. The mediators signal other inflammatory cells to
migrate to the airways where they are activated. This causes
injury of the epithelium, prolonged contraction of smooth
muscle and secretion of mucus, as well as swelling and
changes in the involuntary control of the airway.
• Inflamed airways become more narrow and obstructed.
Inflammation also causes hyper responsiveness of the airway,
which also results in excessive narrowing of the airways when
a stimulus is introduced. Stimuli can include viral respiratory
infections, such as colds, which trigger most attacks.
• Other stimuli are allergens such as pollen or mold; irritants
such as tobacco smoke, cold air or exercise. "Trigger" is
another term for a stimulus that triggers.
• Airway obstruction can develop suddenly or gradually and
causes the symptoms associated with asthma: wheezing,
coughing, shortness of breath, chest tightness and decreased
endurance.

Diagnosis and Assessment:

• Symptoms of asthma include recurrent episodes of wheezing,

breathlessness, chest tightness, and cough — particularly at
night and in the early morning — and are usually associated
with airflow limitation that is at least partly reversible, either
spontaneously or with treatment. As with other diseases, the
patient history, physical examination, and laboratory testing
are important components of a clinical evaluation for asthma.
• The diagnosis of asthma is based primarily on history and
physical examination. The clinical features a patient exhibits,
particularly the symptoms he complains of and the signs
noted on physical examination, are usually sufficient to make
the diagnosis of asthma. Laboratory tests are mainly used to
 confirm the diagnosis of asthma and to grade its severity.
However, peak flow testing can be used to monitor a patient's
respiratory function in an effort to optimize his clinical
management.
• Laboratory Evaluation
1. Pulmonary Function Tests

2. Spirometry
3. Peak expiratory flow rate
4. Skin tests
5. Blood tests
6. Peripheral blood eusinophils
7. Radiology tests

Therapeutic Management:

• Appropriate asthma management includes asthma education,

diligent monitoring of the woman's pulmonary status as well
as fetal status, avoidance of asthma triggers, immunotherapy
as indicated, and indicated pharmacotherapy.

• Published practice guides include avoidance of asthma

triggers, use of bronchodilators as quick relief drugs for
patients with intermittent problems, and the addition of anti-
inflammatory drugs, e.g. inhaled corticosteroids, in those
patients with persistent asthma.

Nursing Intervention

• Cough Enhancement - Promotion of deep inhalation by the

patient with subsequent generation of high intrathoracic
pressures and compression of underlying lung parenchyma for
the forceful expulsion of air.