ASTHMA

Definition:

 A chronic inflammatory disease of

the airways causing reversible
airflow obstruction

 Most common chronic disease of

childhood and can occur at any age.
Etiology & Risk Factors:
 Hereditary
 Environmental Factors
 Viral Infection

 Allergens

 Air Pollutants

 Exercise and Hyperventilation

 Weather changes
 Emotional Upset
 Laughing, crying and stress

 Food, additives, drugs

Manifestations:

 Chest tightness
 Cough
 Dyspnea
 Wheezing
 Tachypnea and Tachycardia
 Anxiety and Apprehension
 Classification of Asthma:
 Extrinsic Asthma (allergic)
• 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.
 Intrinsic Asthma (non-allergic)
» Intrinsic asthma is not allergy- related, 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.
 Mixed Asthma
• is a mixture of intrinsic and extrinsic
asthma. These people react to some
allergies but their asthma is also
triggered by other things.
PATHOPHYSIOLOGY:
Triggers: infection,
allergens, exercise,
irritants

IgE= mast cells mediated response

Release of mediators from mast cells eosinophils,

macrophages, lymphocytes

Early phase response Late phase response

-Bronchial smoothe muscle Infiltration with eosinophils

constriction and neutrophils
-mucus secretion -inflammation
-vascular leakage -bronchial hyperreactivity
-mucosal edema

-Obstruction of large and small airways Infiltration with monocytes

-air trapping and lymphocytes
-respiratory acidosis hypoxemia
 Classification of Severity
CLASSIFY SEVERITY
Clinical Features Before Treatment

Symptoms Nocturnal FEV1 or PEF

Symptoms
STEP 4 Continuous  60% predicted
Severe Limited physical Frequent Variability > 30%
Persistent activity

STEP 3 Daily 60 - 80% predicted

Attacks affect activity > 1 time week Variability > 30%
Moderate
Persistent
STEP 2  80% predicted
> 1 time a week > 2 times a month
Mild Variability 20 - 30%
Persistent but < 1 time a day

< 1 time a week

STEP 1  80% predicted
Asymptomatic and  2 times a month
Intermittent normal PEF Variability < 20%
between attacks
The presence of one feature of severity is sufficient to place patient in that category.
DIAGNOSTIC TEST:

• Pulmonary Function Tests

(PFTs)
• Arterial Blood Gases
• Skin Testing
• Peak Expiratory Flow Rate
Nursing Diagnoses:
• Ineffective Airway Clearance r/t
increased production/ retained
pulmonary secretions
• Impaired Gas Exchange r/t altered
delivery of inspired O2 /air trapping
• Ineffective Breathing Pattern
• Anxiety
 Pharmacological therapy
Relievers
 inhaled fast-acting
ß2-agonists
 inhaled anticholinergics
Controllers
 inhaled corticosteroids
 inhaled long-acting ß2-
agonists
 inhaled cromones
 oral anti-leukotrienes
 oral theophyllines
 oral corticosteroids
RELIEVERS MEDICATION

– Quick relief medicine or rescue

medicine.

– Rapid acting bronchodilators that

act to relieve bronchoconstriction.
 Short-acting inhaled B-agonist
• Use intermittently to control
episodes of bronchoconstriction
• Avoid regular scheduled use if
possible
• An increase use is an indication of
deteriorating control
 LONG ACTING 2 AGONIST

• Mechanism of action:
– Bronchodilator
– Enhance mucociliary clearance
– Modulate mediators release from mast cells and
basophils

• Example : Inhaled : Salmeterol , formeterol

Oral : Bambuterol
Salbutamol SR
Terbutaline SR
Clenbuterol
 LONG ACTING 2 AGONIST

• Inhaled 2 Agonists have fewer side effects than oral

formulations.

• Side-effects : tachycardia, palpitations, tremors, anxiety,

headache and hypokalaemia.
 CONTROLLER MEDICATIONS
• Are medications taken daily on a long term basis that
are useful in getting and keeping persistent asthma
under control.
• Prophylactic, preventive or maintenance medications
• Include
» Inhaled glucocorticosteroids
» Systemic glucocorticosteroids
» Theophylline
» Long acting inhaled 2 agonist
» Long acting oral 2 agonist
» Leukotriene modifiers
 GLUCOCORTICOSTEROIDS
• Mechanisms of action :

– Reduced airway inflammation

– Efficacy in improving lung function, decreasing airways

hyperresponsiveness, reducing symptoms, reducing
frequency and severity of exacerbations and improving
quality of life.
 METHYLXANTHINES

• Mechanism of action: Antiinflammatory

effects & bronchodilator.
• Side effects :
– GIT Symptoms – nausea, vomiting
– CVS Symptoms – tachycardia, arrhythmias
– Drug interaction : Erythromycin, cimetidine and
rifampicin
 Anti-cholinergics
• Inhaled ipratropium bromide.

• Mechanism of action : Bronchodilator.

• Efficacy : Bronchodilator actions are less potent

than those of inhaled ß2-agonists, slower onset
of action which peaks 30 – 60 min.

• Side-effect : Dry mouth.

LEUKOTRIENE MODULATORS

• MECHANISM OF ACTION :
– Block the synthesis of all leukotrienes

• Example : montelukast ( Singulair ),

Zafirlukast
Treatments:
The Global Initiative for Asthma 6-point plan
• Educate patients to develop a partnership in asthma
management.
• Assess and monitor asthma severity with symptom reports
and measures of lung function as much as possible.
• Avoid exposure to risk factors.
• Establish medication plans for chronic management in
children and adults.
» Establish individual plans for managing
exacerbations.
» Provide regular follow-up care.
• Clean the house at least once a week and wear a mask while
doing it
• Avoid pets with fur or feathers
• Wash the bedding (sheets, pillow cases, mattress pads)
weekly in hot water
• Encase the mattress, pillows and box springs in dust-proof
covers
• Replace bedding made of down, kapok or foam rubber with
synthetic materials
• Consider replacing upholstered furniture with leather or vinyl
» Consider replacing carpeting with hardwood
floors or tile
» Use the air conditioner
» Keep the humidity in the house low
Thank
You…

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