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Published by Lizeth Querubin

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Published by: Lizeth Querubin on Oct 04, 2008
Copyright:Attribution Non-commercial


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Asthma is a chronic lung disease characterized by:
Airway inflammation.
Airway hyper responsiveness to various stimuli such asa virus, allergen or exercise.
Airway obstruction or narrowing that is reversible, withtreatment or spontaneously.
 The underlying problem is inflammation as a result of complexinteractions among inflammatory cells, mediators and thetissues in the airways.
Stimuli activate the release of inflammatory mediators frommast cells, macrophages, eusinophils and other cells in theairways. The mediators signal other inflammatory cells tomigrate to the airways where they are activated. This causesinjury of the epithelium, prolonged contraction of smoothmuscle and secretion of mucus, as well as swelling andchanges 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 whena stimulus is introduced. Stimuli can include viral respiratoryinfections, such as colds, which trigger most attacks.
Other stimuli are allergens such as pollen or mold; irritantssuch as tobacco smoke, cold air or exercise. "Trigger" isanother term for a stimulus that triggers.
Airway obstruction can develop suddenly or gradually andcauses the symptoms associated with asthma: wheezing,coughing, shortness of breath, chest tightness and decreasedendurance.Diagnosis and Assessment:
Symptoms of asthma include recurrent episodes of wheezing,breathlessness, chest tightness, and cough — particularly atnight and in the early morning — and are usually associatedwith airflow limitation that is at least partly reversible, eitherspontaneously or with treatment. As with other diseases, thepatient history, physical examination, and laboratory testingare important components of a clinical evaluation for asthma.
 The diagnosis of asthma is based primarily on history andphysical examination. The clinical features a patient exhibits,particularly the symptoms he complains of and the signsnoted on physical examination, are usually sufficient to makethe 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'srespiratory function in an effort to optimize his clinicalmanagement.
Laboratory Evaluation1.Pulmonary Function Tests2.Spirometry3.Peak expiratory flow rate4.Skin tests5.Blood tests6.Peripheral blood eusinophils7.Radiology tests Therapeutic Management:
Appropriate asthma management includes asthma education,diligent monitoring of the woman's pulmonary status as wellas fetal status, avoidance of asthma triggers, immunotherapyas indicated, and indicated pharmacotherapy.
Published practice guides include avoidance of asthmatriggers, use of bronchodilators as quick relief drugs forpatients with intermittent problems, and the addition of anti-inflammatory drugs, e.g. inhaled corticosteroids, in thosepatients with persistent asthma.Nursing Intervention
Cough Enhancement - Promotion of deep inhalation by thepatient with subsequent generation of high intrathoracicpressures and compression of underlying lung parenchyma forthe forceful expulsion of air.

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