INTRODUCTION:

Asthma is a chronic, reversible, obstructive airway disease, characterized

by wheezing. It is caused by a spasm of the bronchial tubes, or the swelling
of the bronchial mucosa, after exposure to various stimuli.
Asthma is the most common chronic disease in childhood. Most children
experience their first symptoms by 5 years of age.
ETIOLOGY:
Asthma commonly results from hyperresponsiveness of the trachea and
bronchi to irritants. Allergy influences both the persistence and the severity
of asthma, and atopy or the genetic predisposition for the development of
an IgE-mediated response to common airborne allergens is the most
predisposing factor for the development of asthma.
CLASSIFICATION:
1. Extrinsic Asthma called Atopic/allergic asthma. An
allergen or an antigen is a foreign particle which enters the body. Our
immune system over-reacts to these often harmless items, forming
antibodies which are normally used to attack viruses or bacteria. Mast
cells release these antibodies as well as other chemicals to defend the
body.
Common irritants:

Cockroach particles

Cat hair and saliva

Dog hair and saliva

House dust mites

Mold or yeast spores

Metabisulfite, used as a preservative in many beverages and

some foods

Pollen

2. Intrinsic asthma called non-allergic asthma, is not allergyrelated, in fact it is caused by anything except an allergy. It may be caused

by inhalation of chemicals such as cigarette smoke or cleaning agents,

taking aspirin, a chest infection, stress, laughter, exercise, cold air, food
preservatives or a myriad of other factors.

Smoke

Exercise

Gas, wood, coal, and kerosene heating units

Natural gas, propane, or kerosene used as cooking fuel

Fumes

Smog

Viral respiratory infections

Wood smoke

Weather changes

ANATOMY AND PHYSIOLOGY:

The upper respiratory tract consists
of the nose, sinuses, pharynx,
larynx, trachea, and epiglottis.
The lower respiratory tract consist of
the bronchi, bronchioles and the
lungs.
The major function of the respiratory system is to deliver oxygen to arterial
blood and remove carbon dioxide from venous blood, a process known
as gas exchange.
The normal gas exchange depends on three process:

Ventilation is movement of gases from the atmosphere

into and out of the lungs. This is accomplished through the
mechanical acts of inspiration and expiration.

Diffusion is a movement of inhaled gases in the alveoli

and across the alveolar capillary membrane

Perfusion is movement of oxygenated blood from the

lungs to the tissues.

Control of gas exchange involves neural and chemical

process
The neural system, composed of three parts located in the pons, medulla
and spinal cord, coordinates respiratory rhythm and regulates the depth of
respirations
The chemical processes perform several vital functions such as:

regulating alveolar ventilation by maintaining normal blood

gas tension

guarding against hypercapnia (excessive CO in the blood) as

2

well as hypoxia (reduced tissue oxygenation caused by

decreased arterial oxygen [PaO ]. An increase in arterial
2

CO (PaCO ) stimulates ventilation; conversely, a decrease in

2

PaCO inhibits ventilation.

2

helping to maintain respirations (through peripheral

chemoreceptors) when hypoxia occurs.

The normal functions of respiration O and CO tension and

2

chemoreceptors are similar in children and adults. however, children

respond differently than adults to respiratory disturbances; major areas of
difference include:

Poor tolerance of nasal congestion, especially in infants who

are obligatory nose breathers up to 4 months of age

Increased susceptibility to ear infection due to shorter,

broader, and more horizontally positioned eustachian tubes.

Increased severity or respiratory symptoms due to smaller

airway diameters

A total body response to respiratory infection, with such

symptoms as fever, vomiting and diarrhea.

SIGNS AND SYMPTOMS:

1.

Non Productive to Productive Cough

2.

Dyspnea

3.

Wheezing on expiration

4.

Cyanosis

5.

Mild apprehension and restlessness

6.

Tachycardia and palpitation

7.

Diaphoresis

PATHOPHYSIOLOGY:
CLINICAL MANIFESTATIONS:
1.

Increased respiratory rate

2.

Wheezing (intensifies as attack progresses)

3.

Cough (productive)

4.

Use of accessory muscles

5.

Distant breath sounds

6.

Fatigue

7.

Moist skin

8.

Anxiety and apprehension

9.

Dyspnea

Steps of Clinical and Diagnostic as per National Asthma

Education and Prevention Program
Mild Intermittent Asthma

Symptoms ? 2 times per week

Brief exacerbations

Nighttime symptoms ? 2 times a month

Asymptomatic and normal PEF (peak expiratory flow)

between exacerbations

PEF or FEV, (forced expiratory volume in 1 second) ? 80% of

predicted value

PEF variability < 20%

Mild Persistent Asthma

Symptoms > 2 times/week, but less than once a day

Exacerbations may affect activity

Nighttimes symptoms > 2 times a month

PEF/FEV ? 80% of predicted value

PEF variability 20%-30%

Moderate Persistent Asthma

Daily Symptoms

Daily use of inhaled short-acting ? agonists

Exacerbations affect activity

Exacerbations ? 2 times a week

Exacerbations may last days

Nighttime symptoms > once a week

PEF/FEV > 60%-<80% of predicted value

PEF variability > 30%

Severe Persistent Asthma

Continual symptoms

Frequent exacerbations

Frequent nighttime symptoms

Limited physical activity

PEF or FEV ? 60% of predicted value

PEF variability > 30 %

LABORATORY AND DIAGNOSTIC FINDINGS:

Spirometry will detect:
a. Decreased for expiratory volume (FEV)
b. Decreased peak expiratory flow rate (PEFR)
c. Diminished forced vital capacity (FVC)
d. Diminished inspiratory capacity (IC)
NURSING MANAGEMENT:
1. Assess respiratory status by closely evaluating breathing patterns and
monitoring vital signs
2. Administer prescribed medications, such as bronchodilators, antiinflammatories, and antibiotics
3. Promote adequate oxygenation and a normal breathing pattern

4. Explain the possible use of hyposensitization therapy

5. Help the child cope with poor self-esteem by encouraging him to
ventilate feelings and concerns. Listen actively as the child speaks, focus
on the childs strengths, and help him to identify the positive and negative
aspects of his situation.
6. Discuss the need for periodic PFTs to evaluate and guide therapy and to
monitor the course of the illness.
7. Provide child and family teaching. Assist the child and family to
namesigns and symptoms of an acute attack and appropriate treatment
measures
8. Refer the family to appropriate community agencies for assistance.