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ASTHMA AND CYSTIC

FIBROSIS

CHINCHU
M

ASTHMA

DEFINITION
Asthma

is defined as intermittent, reversible


obstructive airway disease. Clinically it
manifests as recurrent episodes of wheezing,
dyspnea, chest tightness, and cough. It is
now known to be a chronic inflammatory
disorder of the airways.

ETIOLOGY
Respiratory

infections

Allergens
Weather

changes

Exercise
Emotional

factors

GERD
Inflammation

of upper airways

RISK FACTORS
Age
Heredity
Gender
Maternal

smoking

Ethnicity
Previous

life threatening attacks


Lack of access to medical care

When does Asthma begin?


By 1 year 26%
1-5 years 51.4%
> 5 years 22.3%

77% Of Asthma
Begins In Children
Less Than 5 Years

Ind J Ped 2002;69:309-12

Asthma Inflammation Cells and Mediators

Mechanism Asthma Inflammation

Source: Peter J. Barnes, MD

Asthma Inflammation

Clinical Features

Recurrent Wheeze

Recurrent Cough

Recurrent Breathlessness

Activity Induced Cough/Wheeze

Nocturnal Cough/Breathlessness

Tightness Of Chest
Asthma by Consensus, IAP 2003

Symptomatology
Cough

90%
Wheezing 74%
Exercise induced wheeze or cough 55%

Ind J Ped 2002;69:309-12

Diagnostic evaluation
History
Physical

examination
Clinical features
Laboratory test
Radiographs
PEFR

NORDIC CONSENSUS
Confirm Asthma if,
If the child is having 3 attacks of airway obstruction in
last 1 yr.

If the child gets 1 attack of asthmatic symptoms after


the age of 2 yrs.

Irrespective of age in an attack in children with


allergy (eczema, food allergy etc.) or history of atopy.
If the child does not become free of symptoms when
infection has ceased or has persistent symptoms for
more than a month.
Respir Med. 2000;94(4):299-327

IAP GUIDELINES
3 Or More Episodes Of Airflow Obstruction With Several Of
The Following:
Afebrile Episodes
Personal Atopy Or Family H/O Atopy / Asthma
Nocturnal Exacerbations
Exercise/Activity Induced Symptoms
Trigger Induced Symptoms
Seasonal Exacerbations
Relief With Bronchodilators Oral Steroid

Asthma by Consensus, The Indian Academy of Pediatrics 2003

Asthma Treatments

Classified into Controllers and Relievers

Controllers medications to be taken on daily long term basis.

Relievers medications to be used on as-needed basis to


relieve symptoms quickly.

Asthma treatment
Adrenergic

agonist
Corticosteroids
Anticholinergics
Methylxanthines
Magnesium
Heliox

Asthma management and prevention

The goals for successful management of asthma are

1.

Achieve and maintain control of symptoms

2.

Maintain normal activity levels, including exercise

3.

Maintain pulmonary function as close to normal as possible

4.

Prevent asthma exacerbations

5.

Avoid adverse effects from asthma medications

6.

Prevent asthma mortality

Assess, Treat and Monitor Asthma

The goal of asthma treatment can be reached in most patients


through a continuous cycle that involves assessing, treating and
monitoring asthma.

Each patient should be assessed to establish his/her current


treatment regimen, adherence to the current regimen, and level of
asthma control.

Each patient is assigned to one of five treatment steps.

At each treatment step, reliever medication should be provided for


quick relief of symptoms as needed.

NURSING MANAGEMENT
Regular

monitoring and assessment of the


symptoms in the past 2 weeks.
Assess for exacerbation, proper compliance
to medications.
Assess for difficulty with feedings, changes in
respiratory rate, altered sleep patterns,
presence of retractions, decreased appetite
and weight loss.

Teach

the parents to control or minimize the


exposure to allergens.
Emphasize the need for flu vaccine for
patients with no restrictions.
Limit the exposure to cigarette smoke
Eliminate dust mites
Encourage to use air conditioners at home
and keep doors and windows closed to
minimize the exposure to these triggers.

Encourage

a regular visit to the physician and


evaluate the proper usage of equipment.
Provide a written instruction for management
plans when at home, at school or care givers.
Remind the parents or care givers about the
medications, its expiry date as well as having
a reserve of it in times of exacerbations.
Give an easy telephone access when the
patient must be taken into the hospital.

CYSTIC FIBROSIS

Cystic Fibrosis

Cystic fibrosis (CF) - inherited autosomal recessive


disorder in children
Most common cause of chronic lung disease in
children 30,000 children & adults in US
Incidence

Annually 1,000 children diagnosed


70% of patients are diagnosed by age 2
40% of CF population is age 18 and older

Etiology

Genetically transmitted
disease

Genes (DNA)
From parents

Gene located on 7th


chromosome

2 copies of genes needed to


inherit disease
Carrier states

(National Institutes of Health, n.d.)

Pathophysiology

Defective gene

Related to protein
involved in chloride ion
transport

Body produces thick,


sticky mucus

Clogs the lungs

Stagnant mucus

Obstructs the pancreas

Malabsorption &
malnutrition
(MedlinePlus, 2006)

Symptoms

Symptoms may include

Meconium ileus

Salty-tasting skin

When newborn is kissed

Steatorrhea

Appears at birth

Greasy, bulky and foul smelling

Poor growth/weight gain in spite of good appetite


Chronic coughing, at times with phlegm
Frequent lung infections

Diagnostic Tests

Sweat Test

Measures sodium or
chloride in persons
sweat
Two samples

Ensure false-positive
does not occur

Not reliable on
newborns

Genetic Analysis

Newborn with signs


and symptoms may
confirm diagnosis with
blood test.
Inherited disease

Recommend checking
family members and first
cousins

Treatments

Aimed at relieving symptoms and


complications

Antibiotics

Mucus-thinning drugs

Aerosolized
Thins secretions
Easier to cough up

Bronchodilators

Relaxes smooth muscles in the airways

Treatments

Bronchial airway drainage

Oral enzymes and better nutrition

Postural drainage
High calorie diet
Special vitamins & pancreatic enzymes

Lung transplant
Pain relievers

Ibuprofen

Common Nursing Diagnoses

Ineffective airway clearance r/t tracheobronchial


secretions and obstruction
Imbalanced nutrition: less than body requirements r/t
inability to digest food or absorb nutrients
Risk for infection r/t chronic pulmonary disease
Interrupted family processes r/t chronic illness

Planning & Interventions

Provide respiratory therapy


Administer medications
Meet nutritional needs
Provide psychosocial support
Discharge planning and home teaching

Parent and Child Education

Respiratory infections

Avoid exposure

Chest percussion &


postural drainage
Diet

Community resources
Genetic counseling
Written information

Home care

Support services

Presentation of Disease

Mucous in the airways cannot be easily cleared from the lungs.

Presentation of Disease
Colon

Pancreas
Sticky mucus secretion

Ducts are filled with sticky mucus. Scaring of tissue.

Gene Therapy

Gene therapy is the use of


normal DNA to "correct" for
the damaged genes that
cause disease.
In the case of CF, gene
therapy involves inhaling a
spray that delivers normal
DNA to the lungs.
The goal is to replace the
defective CF gene in the
lungs to cure CF or slow the
progression of the disease.

Thank You