Asthma

Wednesday, January 15, 2020 10:47 PM

A chronic inflammatory disorder of the respiratory track. Most common illness in children. Increased bronchial reactivity to a variety of stimuli, which produces
episodic bronchospasm and airway obstruction. Asthma onset in adulthood: often without distinct allergies. Asthma onset in ch ildhood: often associated with
definite allergens. Prognosis: More than half of asthmatic children become asymptomatic as adults; more than half with onset after age 15 have persistent
disease, with occasional severe attacks. Status asthmaticus is an acute asthma attack that fails to clear with bronchodilator therapy.

Causes and Pathophysiology Assessment

- Allergy - History
○ Family history ○ Intermittent attacks of dyspnea and wheezing
○ Seasonal occurrence ○ Eczema
*Release of mast cell vasoactive and bronchospastic mediators ○ Allergic rhinitis (Hay fever)
- Upper airway infection - Clinical Features
- Exercise ○ Mild wheezing progressing to severe dyspnea
- Anxiety ○ Audible wheezing
- Rarely, coughing or laughing ▪ Initial wheezing can be heard through auscultation
- Paroxysmal airway obstruction associated nasal polyps ○ Chest tightness (feeling not able to breathe)
○ Seen in response to aspirin or indomethacin ingestion ○ Cough productive of thick mucus
Airway obstruction from spasm of bronchial smooth muscle narrows - Other signs
airways; inflammatory edema of the bronchial wall and inspissation of ○ Prolonged expiration
tenacious mucoid secretions are important, particularly in status ○ Intercostal and supraclavicular retraction on inspiration
asthmaticus ○ Use of accessory muscle of respiration
○ Nasal flaring
○ Tachypnea
Confirming Diagnostic Measures ○ Tachycardia
- Physical Examination ○ Perspiration
○ Rhonchi and wheezing throughout the lung fields on expiration, at ○ Flushing
times, inspiration ○ Hay fever (allergic rhinitis)
○ Absent or diminished breath sounds during severe obstruction ○ Eczema
○ Loud bilateral wheezes may be grossly audible
○ Chest is hyperinflated
- Chest X-ray
Therapeutic Management
○ Hyperinflated lungs with air tapping during attack - 4 components
○ Normal during remission ○ Measure asthma assessment and monitoring
- Sputum ▪ History and physical examination
○ Presence of Curschmann's spirals (cast of airways) ▪ Objective testing for asthma severity and control
○ Education for home self-management
○ Charcot-Leyden crystals (microscopic crystals composed of eosinophil
○ Control of environmental factors
protein)
○ Eosinophils ○ Pharmacologic therapy
- Pulmonary Test Function ▪ Beta-adrenergic agents
○ During attacks ▪ Methylxantines
▪ Decreased forced expiratory volumes ▪ Corticosteroids
▪ Increased residual volume - Emergency Treatment
▪ Occasionally, increased total lung capacity; may be normal ○ O2 therapy
between attacks ○ Corticosteroids
- Arterial Blood Gases ○ Bronchodilators
○ Decreased PO2 - Monitor for deteriorating respiratory status
○ Increased PCO2 (in severe attacks) - Note sputum characteristics
- EKG - Provide adequate fluid intake and oxygen, as ordered
○ Sinus tachycardia during attacks - Prevention
○ In severe attacks, cor pulmonae (right axis deviation, peaked p wave) ○ Avoid possible allergens
- Skin Test ○ Use antihistamines, decongestants, cromolyn powder and
○ Identify allergen bronchodilators
○ Explain the influence of stress and anxiety on asthma and frequent
association with exercise (particularly running) and cold air

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