Asthma

-define asthma
 Asthma is a major noncommunicable disease (NCD), affecting both
children and adults, and is the most common chronic disease among
children.

 Inflammation and narrowing of the small airways in the lungs cause

asthma symptoms, which can be any combination of cough, wheeze,
shortness of breath and chest tightness. google
Disease of the airway hyper Asthma is a chronic Inflammatory
responsiveness, mucosal edema, and
Brunner .Mucus production
-identify causes & pathophysiology of asthma. Reversable disease
Scientists continue to explore what causes asthma, but we do know that
these factors play an important role in the development of asthma:

Family history
If you have a parent with asthma, ”ou are three to six times more likely ”o
.develop asthma than someone who does not have a parent with asthma
Allergies
Some people are more likely to develop allergies than others, especially if one
of their parents has allergies. Certain allergic conditions, such as atopic
dermatitis (eczema) or allergic rhinitis (hay fever), are linked to people who
.get asthma
Viral respiratory infections
Respiratory problems during infancy and childhood can cause wheezing.
Some children who experience viral respiratory infections go on to develop
.chronic asthma
Occupational exposures
If you have asthma, exposures to certain elements in the workplace can cause
asthma symptoms. And, for some people, exposure to certain dusts
(industrial or wood dusts), chemical fumes and vapors, and molds can cause
.asthma to develop for the very first time
Smoking
 Cigarette smoke irritates the airways. Smokers have a high risk of asthma.
Those whose mothers smoked during pregnancy or who were exposed to
.secondhand smoke are also more likely to have asthma

Air Pollution
Exposure to the main component of smog (ozone) raises the risk for asthma.
.Those who grew up or live ”n urban areas have a higher risk for asthma
Obesity
Children and adults who are overweight or obese are at a greater risk of
asthma. Although the reasons are unclear, some experts point to low-grade
inflammation in the body that occurs with extra weight. Obese patients often
use more medications, suffer worse symptoms and are less able to control
.their asthma than patients in a healthy weight range
respiratory infections, exercise or physical activity, weather and air
temperature, strong emotions, and some medicines.
Pathophysiology
Normally, the body’s Immune system helps fight infections. But it may also
respond to other things you breathe in, su”h as pollen or mold. In some
people, the Immune system reacts strongly by creating Inflammation .
Race or ethnicity: African Americans and Puerto Ricans are at higher risk of
asthma than people of other races or ethnicities are. African American and
Hispanic children are more likely than non-Hispanic white Americans to die
.from asthma-related causes
Sex: More boys than girls have asthma as children, while asthma Is more
.common among women In teens and adults

Occupational hazards: Breathing In chemicals or industrial dusts in the 

.workplace can raise your risk of developing asthma
When this happens, the airways swell, narrow, and may create more mucus.
The muscles around the airways may also tighten. This can make it even
.harder to breathe. Over time, the airway walls can become thicker
mechanism*
There are two phases of an asthma exacerbation, which include the early
phase and the late phase. The earl” phase is initiated by IgE antibodies that
are sensitized and released by plasma cells. These antibodies respond to
certain triggers In the environment, such as the risk factors listed above. IgE
antibodies then bind to high-affinity mast cells and basophils. When a
pollutant or risk factor gets inhaled, the mast cells release cytokines and
 eventually de-granulate. Released from mast cells are histamine,
prostaglandins, and leukotrienes. These cells, in turn, contract the smooth
muscle and cause airway tightening.[12] Th2 lymphocytes play an integral role
where they produce a series of interleukins (IL-4, IL-5, IL-13) and GM-CSF,
which aid In communication with other cells and sustain inflammation. IL-3
and IL-5 help eosinophils and basophils survive. IL-13 is involved in
remodeling, fibrosis, and hyperplasia.[13] Within the next several hours, the
late phase occurs, I’ which eosinophils, basophils, neutrophils, and helper and
memory T-cells all localize to the lungs as well, which perform
bronchoconstriction and cause inflammation. mast cells also play an
essential role In bringing the late-phase reactants to the inflamed sites.[14] It
is critical to recognize both of these two mechanisms to target therapy and
relieve both bronchoconstriction and inflammation, depending on the severity
of the disease. Interestingly, those with a thicker airway over time have a
longer disease duration due to a narrower airway.[15] As a result o”
inflammation and bronchoconstriction, there is an intermittent airflow
obstruction, resulting in increased work of breathing.
Airway hyperresponsiveness is a crucial feature of asthma; this is an
exaggerated bronchoconstrictor response, usually to different stimuli. There
are a variety of mechanisms leading to airway hyperresponsiveness. Some
explanations are due to increased histamine from mast cells or increase
airway smooth muscle mass. Also, there is an increased vagal tone and
increased intracellular free calcium that further enhances airway smooth
muscle cell contractility
identify types of asthma and asthma classification-
Allergic asthma
Allergic asthma, sometimes called atopic asthma, is asthma triggered by
allergens like pollen, pets, and dust mites. About 80% of people with asthma
have allergies
Seasonal’ asthma

Some people have asthma that only flares up at certain times of the year,
such as during hay fever season, or when it’s cold.

While asthma is usually a long-term condition, it’s possible to be symptom-

free when your triggers aren’t around. It’s still important to keep following
your asthma action plan and to take your preventer inhaler as prescribed.

Occupational asthma

Occupational asthma is asthma caused directly by the work you do. You
might have occupational asthma if:
  your asthma symptoms started as an adult and
 your asthma symptoms improve on the days you’re not at work.

Non-allergic asthma

Non-allergic asthma, also known as non-atopic asthma, is asthma that isn’t

related to an allergy trigger like pollen or dust. It’s less common than allergic
asthma. Non-allergic asthma often develops later in life.

Exercise-induced’ asthma

About 90% of people with asthma have tightening of the airways caused by
exercise. However, this can also occur in people without asthma.

Adult onset asthma

Asthma often starts in childhood, but some people are diagnosed with
asthma for the first time when they’re an adult. This is known as adult onset
asthma or late onset asthma.

Childhood asthma
Some children diagnosed with asthm” find it Improves or disappears
.completely as they get older.”This is known as childhood asthma
However, it can sometimes return later In life
Difficult asYou may have difficult asthma if: You get symptoms three or more
times a week You use your reliever inhaler three or more times a week You
wake up at night because of your asthma one or more times a week
Severe asthma
Severe asthma Is a type of difficult asthma that doesn’t respond to the usual
treatments. Even if your asthma is described as ‘difficult’ and you’re having
lots of asthma attacks, it doesn’t always mean you have severe asthma.
Aspirin-induced asthma
Cough-variant asthma
Steroid-resistant asthma
_classification
Classification Guidelines
Classification includes (1) intermittent asthma, (2) mild persistent asthma, (3)
.moderate persistent asthma, (4) and severe persistent asthma
:Intermittent asthma is characterized as follows
Symptoms of cough, wheezing, chest tightness, or difficulty breathing less
 than twice a week
Flare-ups are brief, but intensity may vary
Nighttime symptoms less than twice a month
No symptoms between flare-ups
Lung function test FEV 1 is 80% or more above normal values
Peak flow has less than 20% variability am-to-am or am-to-pm, day-to-day
:Mild persistent asthma is characterized as follows
Symptoms of cough, wheezing, chest tightness, or difficulty breathing 3-6
times a week
Flare-ups may affect activity level
Nighttime symptoms 3-4 times a month
Lung function test FEV 1 is 80% or more above normal values
Peak flow has less than 20-30% variability
:Moderate persistent asthma is characterized as follows
Symptoms of cough, wheezing, chest tightness, or difficulty breathing daily
Flare-ups may affect activity level
Nighttime symptoms 5 or more times a month
Lung function test FEV 1 is above 60% but below 80% of normal values
Peak flow has more than 30% variability
:Severe persistent asthma is characterized as follows

Symptoms of cough, wheezing, chest tightness, or difficulty breathing that are

continual
Frequent nighttime symptoms
Lung function test FEV 1 is 60% or less of normal values
Peak flow has more than 30% variability
_list signs and symptoms of asthma
CougShortness of breath
Chest tightness or pain
Wheezing when exhaling, which is a common sign of asthma in children
 Trouble sleeping caused by shortness of breath, coughing or wheezing
Coughing or wheezing attacks that are worsened by a respiratory virus, such
as a cold or the flu
:Signs that your asthma is probably worsening include

Asthma signs and symptoms that are more frequent and bothersome
Increasing difficulty breathing, as measured with a device used to check how
well your lungs are working (peak flow meter)
The need to use a quick-relief inhaler more often
‫وﻗﻮﻟﻨﺎ ﻗﺒﻞ ﻛﺪة إن ﻣﻤﻜﻦ ﺣﺎﺟﺎت ﺗﺎﻧﻴﺔ ﺗﺒﻴﻦ اﻷﻋﺮاض زي اﻻﻛﻴﻮﺑﻴﺸﻨﺎل وزي اﻻﻛﺴﺮﻳﺰ واﻻﻟﺮﭼﻲ‬
identify diagnostic studied of asthma-
The main tests used to help diagnose asthma are:
Fractional exhaled nitric oxide FeNO test – you breathe Into a machine that
measures the level of nitric oxide In your breath, whichh is a sign of
inflammation in your lungs
Pulse oximeter. This small device clipped on the end of a finger measures the
amount of oxygen in ’our blood. This shows how well the lungs are ”eliv’ring
oxygen to the blood.
Spirometry – you blow Into a machine that measures how fast you can
breathe out and how much air you can hold in your lungs
Peak flow test “bef”test– you blow Into a handheld device that measures how
fast you can breathe out, ’nd this may be done several times over a few
weeks”to see If it changes over time
After you’re diagnosed with asthma, you may ”lso have a chest X-ray or allergy
.tests to see If your symptoms might be triggered by an allergy

Bronchoprovocation tests
These tests measure how your airways react when you breathe in specific
substances in the air. During this test, you breathe in allergens or medicines
that may tighten the muscles in your airways. How fast the air moves when
you breathe in and out is

Blood tests
asthma diagnosis is based on several factors, including a detailed medical
history, a physical exam, your symptoms, and overall health and test results
_explain medical care for acute asthma
 In emergency room
Oxygen. Oxygen may be given through a tube attached to the nose If there are
.signs of too little oxygen In the blood
Quick-relief medicines. Inhaled quick-relief medicines, such as albuterol and
.levalbuterol, are given either with an inhaler or a nebulizer to open ”Irwa’s
Ipratropium (Atrovent HFA). Ipratropium is a drug also used to open airways
.that is Inhaled with an Inhaler or a nebulizer
Corticosteroids. Corticosteroids are given as a pill or shot to treat
.inflammation
Mechanical ventilation. If an asthma attack Is life-threatening, a machine may
be used to h’lp you breathe and get extra oxygen. This may be ”one with a
breathing mask. But in some cases, a tube is”placed down the throat and into
.the windpipe. This”procedure is called intubation
Yellow zone
The yellow zone of an asthma action plan is having moderate asthma
symptoms and a peak flow reading of 50% to 79% of your personal best
:Quick-relief medicines include
.Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others)
.Levalbuterol (Xopenex, Xopenex HFA)
Red zone
:The red zone In an asthma action tells you to get emergency care if
.You are very short of breath
.The symptoms get worse
.You’re still In the yellow zone after 24 hours
.You can’t do typical activities
.You have a peak flow below 50%
.Your healthcare professional tells you to go
explain nursing care for acute ashtma_
Maintaining Patent Airways & Reducing Airway Inflammation

Assessment :
.Assess respiratory rate, depth, and rhythm
Changes in the respiratory rate and rhythm may Indicate an early sign of
 impending respiratory distress. Tachypnea is usually present to some degree
Assess for color changes in the buccal mucosa, lips, and nail beds.
Cyanosis indicates low oxygenation and that breathing is ineffective in
maintaining adequate tissue oxygenation.
.Auscultate lungs for adventitious breath sounds
Wheezing, a musical, high-pitched, whistling sound produced by airflow
turbulence, is one o’ the most common symptoms. In the mildest form,
w’eezing is only end-expiratory
Assess the effectiveness of cough.
Severe bronchospasm, thick secretions, and respiratory muscle fatigue are
some of the caus”s of an Ineffective cough
.Assess the amount, color, odor, and viscosity of the secretions
Normal secretion is clear or gray and minimal; abnormal sputum is green,
yellow, or bloody; mal’dorous; often copious. Thick tenacious secretions
Increase”airway resistance
Monitor oxygen saturation using pulse oximetry.
Oxygen saturation of less than 90% indicates problems with oxygenation.
Monitor chest x-ray results.
A chest x-ray provides information regarding the presence of infiltrates, lung
Inflation
Monitor laboratory results as indicated.
Urea and electrolytes should be taken if the client has a high dose or repeat
salbutamol,
Monitor arterial blood gasses (ABGs).
ABG measurement provides important information in acute asthma
Obtain peak expiratory flow rate (PEFR) or forced expiratory volume in 1
.second (FEV1) be’ore and after respiratory treatment
‫اﻟﺤﻠﻮل‬
Pace the client’s activities.
Break up activities Into smaller parts and take rest breaks in between to avoid
.fatigue and I’crease effort in breathing properly
.Encourage deep breathing and coughing exercises
Deep breathing exercises help loosen and expectorate excess secretions and
.contribute to effectively clearing mucus out of the lungs
.Encourage the client to maintain a comfortable position to facilitate breathing
Assist the client by elevating the head ’f the bed and allowing them to lean
;over a bed t”ble to facilitate respiratory function using gravity
Keep environmental pollution from sources such as dust, smoke, and feather
.pillows to a minimum
It has been shown that environmental In’erventions can reduce relevant indoor
allergen and pollutant exposures and they are associated with clear
.improvements in asthma
Encourage increased fluid Intake of up to 3000 ml/day within the cardiac or
.renal reserve
Fluids help minimize mucosal drying and increase ciliary action to remove
secretions
.Limit alcohol and caffeinated drinks
Alcohol and caffeinated drinks can Increase the client’s gastric acid secretion
Administer high-flow nasal cannula (HFNC) oxygen therapy as ordered.
HFNC effectively elevates PO2 in clients diagnosed with severe bronchial
asthma
Assist with respiratory treatments such as spirometry and chest
.physiotherapy
Short-acting beta-2 adrenergic agonist agents
Anticholinergic
Oral corticosteroids inhaler
_identify medical care for chronic ashtma
Inhaled corticosteroids. These medications include fluticasone propionate
(Flovent HFA, Flovent Diskus, Xhance), budesonide (Pulmicort Flexhaler,
Pulmicort Respules, Rhinocort), ciclesonide
Leukotriene modifiers. These oral mCombination inhalers. These medications
— such as fluticasone-salmeterol (Advair HFA, Airduo Digihaler, others),
Theophylline. Theophylline (Theo-24, Elixophyllin, Theochron) is a daily pill
that helps keep th” airways open by relaxing the muscles around the aOral and
Intravenous corticosteroids. These medications — which includShort-acting
beta agonists. These inhaled, quick-relief bronchodilators act within minutes
to rapidly ease symptoms during an asthma attack.e prednisone quick relief
medications
Biologics
 describe long term nursing care for chronic asthma_
Providing Patient Education & Health Teachings
.Assess the client’s cognitive ability and educational attainment
Lower educational attainment contributes to limited health literacy, which
.directly affects health
Assess the client’s knowledge of care for asthma and status asthmaticus,
as appropriate.
Knowledge of how to handle care can save time
Assess past and present therapies, Including the client’s response to them.
Knowledge of what has been effective In the past determines the appropriate
.Intervention needed
.Assess the client’s knowledge of asthma triggers
Environmental exposures and Irritants play a major role in symptom
.exacerbations
Assess the client’s tobacco use.
Assessment of tobacco use Is important for clients suffering from lung
.disease
.Assess the client’s knowledge and ability to use asthma medications
Inhaler mishandling remains a serious issue and clients need education on
.the proper Inhale” use by healthcare providers
Evaluate self-care activities such as preventive care and home management
of an acute attack.
Since it is a chronic disease, the client must be able to self-manage the
disease.
Explain the disease to the client and t’eir significant others.
A misconception regarding asthma attacks Is that they can be managed
without medication through self-control and discipline
.Instruct the client on how to avoid asthma triggers
Environmental trigger control can lessen the frequency of asthma attacks and
improve the client’s quality of life

Educate the client about the warning signs and symptoms of an asthma
attack and the Importance of early treatment of an impending attack. Provide
.a written copy of daily exacerbation management
A written, individualized, daily self-management plan Is needed by the client to
reinforce the ”information that was already taught.
Review all medications with the client includeincludeing a discussion of short
versus long-acting medications, a review of zones, and the dosage of
.each’medication in each zone
Short-acting beta-agonists are the first-line medication of choice since they
relieve acute asthma attacks very quickly compared to long-acting. Beta-2-
adrenergic agonists should be used before inhaled steroids since they open
the airways
Reinforce the need for taking controller medications and educate about their
side effects as indicated.
Asthma is a chronic condition that is present even when attacks are not
occurring.
Teach how to administer nebulizer treatments, Diskus, MDIs spacers, or dry
powder capsules with the correct technique.
Instruct in the use of peak flow meters and develop an Individualized plan on
how to adjust medications and w’en to seek medical advice. Establish the
client’s personal best peak expiratory flow rate (PEFR).
Discuss the Importance of the pneumococcal pneumonia vaccine and
influenza vaccine yearly
Review breathing exercises, effective coughing techniques, and general
conditioning exercises.
_complications
lifestyle complications_
Sleep Difficulties and Fatigue

Many people with asthma experience insomnia (difficulty falling asleep or

staying asleep) and disrupted sleep due to asthma symptoms such as
coughing and wheezing.

Physical Inactivity and Related Complications

Some people with asthma don’t exercise regularly due to their symptoms.

Medical Complications of Asthma

When left untreated, chronic asthma symptoms can lead to various medical
:complications, including

Asthma Medication Side Effects

 Corticosteroids are often prescribed to treat chronic asthma symptoms.
These anti-inflammatory drugs are used to reduce swelling in the bronchial
:airways.7 However, they ”ave some potential side effects, including

Insomnia (difficulty falling asleep or staying asleep)

Weight gain
Thrush (an oral yeast Infection)
Elevated eye pressure (glaucoma)
Elevated blood pressure
Cataracts (clouding of the clear lens of the eye)
Infections
Bruising
Osteoporosis (thinning and weakening of bones)
GERD
Up to 80% of people with asthma also have symptoms of gastroesophageal
reflux disease (GERD), whichh causes heartburn due to the return of stomach
acid into the ’sophagus.8 Symptoms of GER’ can trigger and worsen asthma
.symptoms (and vice versa). Treating GERD can help with asthma symptoms

Chronic Inflammation and Airway Remodeling

Chronic inflammation from severe asthma can eventually le”d to airway
remodeling, which refers to the permanent narrowing of the airways in the
.lungs

Airway remodeling can permanently affect lung function, leading to ongoing

breathing problems.9 It’s associated with chronic obstructive pulmonary
disease (COPD), a group ”f progressive diseases that restri”t airflow
The Flu
Even people with mild asthma are more at risk of developing serious
complications from the flu. The flu virus can also worsen asthma symptoms,
potentially leading to Infections and a greater risk of hospitalization
Pneumonia