ASTHMA

ASTHMA
DEFINITION
 Reactive airway disease
 Chronic inflammatory lung disease

Inflammation causes varying degrees of obstruction in the

airways
 Asthma is reversible in early stages
TRIGGERS OF ASTHMA

 Allergens
 Exercise
 Respiratory Infections
 Nose and Sinus problems
 Drugs and Food Additives
 GERD
 Emotional Stress
ASTHMA
PATHOPHYSIOLOGY

 Bronchospasm
 Airway inflammation
ASTHMA
PATHOPHYSIOLOGY

Early-Phase Response
 Peaks 30-60 minutes post exposure, subsides 30-90 minutes later
 Characterized primarily by bronchospasm
 Increased mucous secretion, edema formation, and increased
amounts of tenacious sputum
 Patient experiences wheezing, cough, chest tightness, and dyspnea
ASTHMA
PATHOPHYSIOLOGY
Late-Phase Response
 Characterized primarily by inflammation
 Histamine and other mediators set up a self-
sustaining cycle increasing airway reactivity
causing hyperresponsiveness to allergens and
other stimuli
 Increased airway resistance leads to air trapping
in alveoli and hyperinflation of the lungs
 If airway inflammation is not treated or does not
resolve, may lead to irreversible lung damage
FACTORS CAUSING AIRWAY OBSTRUCTION IN
ASTHMA

Fig. 28-3
ASTHMA
CLINICAL MANIFESTATIONS
 Unpredictable and variable

 Recurrent episodes of wheezing, breathlessness, cough,

and tight chest
ASTHMA
CLINICAL MANIFESTATIONS
 Expiration may be prolonged from a inspiration-
expiration ratio of 1:2 to 1:3 or 1:4

 Between attacks may be asymptomatic with normal or

near-normal lung function
ASTHMA
CLINICAL MANIFESTATIONS
 Wheezing is an unreliable sign to gauge severity of
attack
 Severe attacks can have no audible wheezing due to
reduction in airflow
 “Silent chest” is ominous sign of impending respiratory
failure
ASTHMA
CLINICAL MANIFESTATIONS

Difficulty with air movement can create a feeling of

suffocation
 Patientmay feel increasingly anxious
 Mobilizing secretions may become difficult
ASTHMA
CLINICAL MANIFESTATIONS
Examination of the patient during an acute attack usually
reveals signs of hypoxemia
 Restlessness
 Increased anxiety
 Inappropriate behavior
 Increased pulse and blood pressure
 Pulsus paradoxus (drop in systolic BP during inspiratory
cycle >10)
ASTHMA
COMPLICATIONS

Status asthmaticus
Severe, life-threatening attack refractory to
usual treatment where patient poses risk for
respiratory failure
ASTHMA
DIAGNOSTIC STUDIES

 Detailed history and physical exam

 Pulmonary function tests

 Peak flow monitoring

 Chest x-ray

 ABGs
ASTHMA
DIAGNOSTIC STUDIES

 Oximetry
 Allergy testing

 Blood levels of eosinophils

 Sputum culture and sensitivity

MANAGEENT OF ASTHMA
 Education
 Startat time of diagnosis
 Integrated into every step of clinical care

 Self-management
 Tailored to needs of patient
 Emphasis on evaluating outcome in terms of patient’s
perceptions of improvement
Acute Asthma Episode
 O2 therapy should be started and
 monitored with pulse oximetry,vs or ABGs in severe cases
 Inhaled -adrenergic agonists by metered dose using a spacer
or nebulizer
 Corticosteroids indicated if initial response is insufficient
Acute Asthma Episode
Therapy should continue until patient
• is breathing comfortably
• wheezing has disappeared

• pulmonary function study results are near

baseline values
Status asthmaticus
 Most therapeutic measures are the same as for acute
 Increased frequency & dose of bronchodilators
 Continuous -adrenergic agonist nebulizer therapy may be
given
Status asthmaticus
 IV corticosteroids
 Continuous close monitoring
 Supplemental O2 to achieve values of 90%
 IV fluids are given due to insensible loss of fluids
 Mechanical ventilation is required if there is no response to
treatment
ASTHMA
DRUG THERAPY
 Long-term control medications
 Achieve and maintain control of persistent asthma
 Quick-relief medications
 Treat symptoms of exacerbations
ASTHMA
DRUG THERAPY
 Bronchodilators
 -adrenergic agonists

(e.g., albuterol, salbutamol[Ventolin])

 Acts in minutes, lasts 4 to 8 hours
 Short-term relief of bronchoconstriction

 Treatment of choice in acute exacerbations

ASTHMA
DRUG THERAPY
 Bronchodilators
 Useful in preventing bronchospasm precipitated by exercise and
other stimuli
 Overuse may cause rebound bronchospasm

 Too frequent use indicates poor asthma control and may mask

severity
ASTHMA
DRUG THERAPY

 Bronchodilators (longer acting)

 8 – 12 or 24 hr; useful for nocturnal asthma
 Avoid contact with tongue to decrease side effects
 Can be used in combination therapy with inhaled corticosteroid
ASTHMA
DRUG THERAPY
Antiinflammatory drugs
 Corticosteroids (e.g., beclomethasone, budesonide)
 Suppress inflammatory response
 Inhaled form is used in long-term control

 Systemic form to control exacerbations and manage persistent

asthma
ASTHMA
DRUG THERAPY
Antiinflammatory drugs
Corticosteroids
 Do not block immediate response to allergens, irritants, or exercise
 Do block late-phase response to subsequent bronchial

hyperresponsiveness
 Inhibit release of mediators from macrophages and eosinophils
ASTHMA
DRUG THERAPY
Anti-inflammatory drugs
 Mast cell stabilizers (e.g., cromolyn, nedocromil)
 Inhibit release of histamine
 Inhibit late-phase response

 Long-term administration can prevent and reduce

bronchial hyper-reactivity
 Effective in exercise-induced asthma when used 10

to 20 minutes before exercise

ASTHMA
DRUG THERAPY
 Leukotriene modifiers (e.g. Singulair)
 Leukotriene– potent bronchco-constrictors and may cause
airway edema and inflammation
 Have broncho-dilator and anti-inflammatory effects
ASTHMA
PATIENT TEACHING RELATED TO
DRUG THERAPY

Correct administration of drugs is a major factor in

determining success in asthma management
 Some persons may have difficulty using an MDI and therefore
should use a spacer or nebulizer
 DPI (dry powder inhaler) requires less manual dexterity and
coordination
ASTHMA
PATIENT TEACHING RELATED TO
DRUG THERAPY

 Inhalers should be cleaned by removing dust cap and rinsing with

warm water
 -adrenergic agonists should be taken first if taking in conjunction
with corticosteroids