Bronchial Asthma

RITA O.
AGYEI

22019592
OBJECTIVES

By the end of this presentation students will  Pathophysiology

be able to:  Compensation mechanisms
 Define Bronchial Asthma (BA)  Management
 Causes of BA  Monitoring the effectiveness of
 Types and Classification of BA management
 Relationship between Asthma and Covid  Nursing Assessment
19  Nursing diagnosis
 Prevalence rate  Nursing interventions for BA
 Signs and symptoms
 Diagnosis
DEFINITION: Bronchial Asthma
What is Bronchial Asthma?
 Bronchial Asthma commonly known as Asthma is a
chronic lung condition that causes swelling and
narrowing of the tubes that carry air to and from the
lungs resulting in sporadic breathing difficulties.
 It is characterised by periodic "attacks" of coughing,
wheezing, shortness of breath, and chest tightness.
 It often starts in childhood, although it can also
develop in adults, and affects people of all ages. 

 There is currently no cure, but careful management

can help control the symptoms. 
 Patients can live full and rewarding lives with the
right treatment and management. 
https://www.who.int/respiratory/asthma/definition/en/
Causes of Asthma

 The fundamental causes of the disease are

likely to be a combination of genetics – for
example if your parents have it or it is common
in your family.
 External triggers such as Allergens. Example,
dust, mites, pollen, food, perfumes, animal fur
etc.
 Tobacco smoke, pollution and cold air.
 Chemical irritants in the workplace such as
paint, varnishes and adhesives. 
 Other triggers can include extreme emotional
duress, exercise, and for some people, certain
medicines.
https://www.who.int/respiratory/asthma/definition/en/
Types of Asthma

 Adult-Onset Asthma.
 Allergic Asthma.
 Asthma-COPD Overlap.
 Exercise-Induced Bronchoconstriction (EIB)
 Non-allergic Asthma.
 Occupational Asthma
Adult Asthma

 Some people don’t show signs of having asthma until they are adults. This is
known as adult-onset asthma.

 Sometimes, people just manage to essentially avoid their asthma triggers for
years. When they are then exposed to that trigger as an adult, it can bring on
asthma symptoms. For example, they may move in with a roommate who has a
pet, or they may work around certain chemical fumes for the first time.

 Other times, a viral infection can unmask their asthma symptoms. For example,
they may have an upper respiratory infection that leads to a cough that sticks
around for weeks.
Allergic Asthma

 There is often a link between allergies and asthma.

 Not everyone who has allergies has asthma, and not everyone with asthma has
allergies. But allergens such as pollen, dust and pet dander can trigger asthma
symptoms and asthma attacks in certain people. This is called allergic asthma.
Asthma-COPD Overlap.
 Asthma is considered severe when it is difficult to
treat and manage the symptoms.

 Chronic obstructive pulmonary disease (COPD) is a

collection of lung diseases that cause breathing
problems and obstruct airflow. This group of
diseases can include refractory (severe) asthma,
emphysema and chronic bronchitis.

 Most people with asthma will not develop COPD,

and many people with COPD don’t have asthma.
However, it’s possible to have both. Asthma-COPD
overlap syndrome (ACOS) occurs when someone
has these two diseases at once.
Exercise-Induced Bronchoconstriction
(EIB)
 Exercise-induced bronchoconstriction, or EIB, is the preferred term for
what was known for years as exercise-induced asthma.
 Symptoms develop when airways narrow as a result of physical activity.
As many as 90 percent of people with asthma also have EIB, but not
everyone with EIB has asthma.
 EIB is caused by the loss of heat, water or both from the airways during
exercise when quickly breathing in air that is drier than what is already in
the body.
 Symptoms typically appear within a few minutes after you start exercising
and may continue for 10 to 15 minutes after you finish your workout.
Nonallergic Asthma.

As the name implies, nonallergic asthma is triggered by factors other than allergens.
These can include:

Viral respiratory infections

Exercise
Irritants in the air
Stress
Drugs and certain food additives
Weather conditions
Occupational Asthma

 The Occupational Safety and Health Administration (OSHA) reports that an

estimated 11 million workers in a wide range of industries and occupations in the
United States are exposed to at least one of the more than 250 substances known
or believed to cause or exacerbate occupational asthma.
 Occupational factors are associated with up to 15 percent of disabling asthma
cases.
 Triggers may include chemicals used in manufacturing; paints; cleaning products;
dusts from wood, grain and flour, latex gloves, certain molds, animals, and
insects.
 Factors that increase the risk for developing occupational asthma include existing
allergies or asthma, a family history of allergies or asthma, and cigarette smoking.
 Types or classification of Bronchial Asthma

Asthma is classified into four categories based on frequency of

symptoms and objective measures such as peak flow measurements
and/or spirometry results.
 These categories are, Mild Intermittent, Mild
Persistent, Moderate Persistent, And Severe Persistent.
 A physician will determine the severity and control of Asthma based
on how frequent the symptoms occur and on lung function tests.
 It is important to note that a person's asthma symptoms can change
from one category to another.
 Mild Intermittent Asthma
Symptoms occur less than twice a week, and
nighttime symptoms occur less than two times
per month.
Lung function tests are 80% or more above
predicted values. Predictions are often made on
the basis of age, sex, and height.
No medications are needed for long-term
control.
Mild Persistent Asthma

Symptoms occur three to six times per

week.
Lung function tests are 80% or more
above predicted values.
Nighttime symptoms occur three to
four times a month.
 Moderate Persistent Asthma
Symptoms occur daily.
Nocturnal symptoms occur 5 or more times per month.
Asthma symptoms affect activity, occur more than two
times per week, and may last for days.
There is a reduction in lung function, with a lung
function test range above 60% but below 80% of
normal values.
 Severe Persistent Asthma
Symptoms occur continuously, with frequent
night- time attacks 
Activities are limited.
Lung function is decreased to less than 60% of
predicted values.
The late and severe symptoms of Asthma

 If early warning signs and symptoms are not recognized and treated, the asthma episode can
progress and symptoms might worsen.
 As symptoms worsen, you might have more difficulty performing daily activities and sleeping.
 A cough that won't go away (day and night)
 Wheezing
 Tightness in the chest
 Shortness of breath
 Poor response to quick relief, inhaled medicines (bronchodilators)
 Very rapid breathing
 Inability to catch your breath
 Chest pain or pressure
 Difficulty talking
 Inability to fully exhale
 Feelings of anxiety or panic
 Pale, sweaty face
 Blue lips or fingernails
RELATIONSHIP BETWEEN
ASTHMA AND COVID19
B .A PREVALENCE

 It was estimated that more than 339

million people suffer from asthma out
of the 7.424 billion people in the world
 This means that 4.57% peoples in the
world are asthmatic.
 Mortality 10% to 15% yearly.

Global, regional, and national incidence, prevalence, and

years lived with disability for 328 diseases and injuries for
195 countries, 1990–2016: a systematic analysis for the
Global Burden of Disease Study 2016. Lancet 2017; 390:
1211–59.

Global Health Estimates 2016: Deaths by Cause, Age, Sex,

by Country and by Region, 2000-2016. Geneva, World
Health Organization; 2018.

Global Health Estimates 2016: Disease burden by Cause,

Age, Sex, by Country and by Region, 2000-2016. Geneva,
World Health Organization; 2018
 Signs and Symptoms OF Bronchial
Asthma
 Common symptoms include breathlessness, coughing and wheezing. 
 Frequent cough, especially at night
 Losing your breath easily or shortness of breath
 Feeling very tired or weak when exercising
 Wheezing or coughing during or after exercise
 Decreases or changes in a peak expiratory flow
 Signs of a cold, upper respiratory infection, or allergies (sneezing, runny nose,
cough, congestion, sore throat, and headache)
 Trouble sleeping
DIAGNOSING ASTHMA
CONT.
Specific investigation
 Respiratory function test:
 1. peak expiratory flow
 2. spirometry

 exercise tests
 -histamine/methacholine bronchial
 provocation test
 - trial of corticosteroids
Non-specific investigation

 - full blood count and differential count:

 increase number of eosinophils
 - arterial blood gases
 - sputum test: number of eosinophils
 - chest X-ray: hyperinflated
Cont.

Reversibility Test
 This test is done to see whether the obstruction can be relieved by the use of a
short-acting bronchodilator eg salbutamol.
 An improvement of 15% or more (as measured on the peak flow meter) is
diagnostic of asthma.
 However, in severe chronic disease or patient who has treated with long-acting
bronchodilators, little reversibility will be demonstrated.
 Pathophysiology of BA
 The concepts underlying asthma pathogenesis have evolved dramatically in
the past 25 years and are still undergoing evaluation.(Busse and Lemanske 2001. 
EPR—2, 1997).
Airflow limitation in asthma is recurrent and caused by a variety of changes in the airway.
These include:
 Bronchoconstriction
 Airway edema
 Airway hyper-responsiveness
 Airway remodeling
 In asthma, the dominant
physiological event leading to
clinical symptoms is airway
narrowing and a subsequent
interference with airflow.
Bronchocons
In acute exacerbations of asthma, triction
bronchial smooth muscle contraction
(bronchoconstriction) occurs quickly
to narrow the airways in response to
exposure to a variety of stimuli
including allergens or irritants.
As the disease becomes more persistent
and inflammation more progressive,
other factors further limit airflow.

These include edema, inflammation,

mucus hypersecretion and the formation
of inspissated mucus plugs, as well as
Airway
structural changes including hypertrophy edema
and hyperplasia of the airway smooth
muscle.

These latter changes may not respond to

usual treatment
The mechanisms influencing airway
hyperresponsiveness are multiple and include
inflammation, dysfunctional neuro-regulation
and structural changes.

Inflammation appears to be a major factor in Airway

determining the degree of airway hyperrespo
hyperresponsiveness.
nsiveness
Treatment directed toward reducing
inflammation can reduce airway
hyperresponsiveness and improve asthma
control.
 In some persons who have asthma, airflow
limitation may be only partially reversible.

Permanent structural changes can occur in

the airway, these are associated with a
progressive loss of lung function that is not
prevented by or fully reversible by current
therapy.
Airway
Airway remodeling involves an activation remodeling
of many of the structural cells, with
consequent permanent changes in the
airway that increase airflow obstruction and
airway responsiveness and render the
patient less responsive to therapy.
(Holgate and Polosa 2006)
Compensation mechanisms in BA

Children; The performance of invasive procedures in children to evaluate

molecular and cellular mechanisms in asthma is obviously not as feasible from a
variety of standpoints compared with adults.

 However, a few carefully and safely conducted studies in young children have
provided insights into possible pathophysiologic features as they relate to
developmental milestones and disease expression.
When bronchoalveolar lavage has been performed in young wheezing children, a
3-fold increase in total cells, most significantly lymphocytes, polymorphonuclear
cells, and macrophages/monocytes, compared with counts seen in healthy
children has been noted.

In addition, levels of leukotriene B4 and C4, prostaglandin E2, and the potentially
epithelium-derived 15-hydroxyeicosattetranoic acid were all increased.
 Compensation mechanisms in BA
Adults; Asthma for most, but not all, patients
begins in early life. As noted above, the
cellular and molecular patterns associated with
airway inflammation in asthma are complex,
interactive, redundant, and variable. 
 Compensation mechanisms in BA in
adult
In adults, particularly those with established
longstanding disease, the factors that contribute to the
pathophysiology of airway abnormalities are dependent
on the phases of asthma, such as acute, persistent,
severe versus nonsevere, or during treatment
 Treatment to be applied in BA
Asthma can be controlled, but not cured.
It is not normal to have frequent symptoms, trouble
sleeping, or trouble completing tasks.
Appropriate asthma care will prevent symptoms and
visits to the emergency room and hospital.
Asthma medicines are one of the mainstays of asthma
treatment. The drugs used to treat asthma are explained
as;
 These are the most important drugs for most people
with asthma. Anti-inflammatory drugs reduce swelling
and mucus production in the airways. As a result,
airways are less sensitive and less likely to react to
triggers.
Anti- These medications need to be taken daily and may
inflammator need to be taken for several weeks before they begin
ies: to control asthma.
Anti-inflammatory medicines lead to fewer
symptoms, better airflow, less sensitive airways, less
airway damage, and fewer asthma attacks.
If taken every day, they CONTROL or PREVENT
asthma symptoms
 These drugs relax the muscle bands that tighten
around the airways. This action opens the airways,
letting more air in and out of the lungs and
improving breathing. Bronchodilators also help
clear mucus from the lungs. As the airways open,
Broncho the mucus moves more freely and can be coughed
out more easily.
dilators: In short-acting forms, bronchodilators RELIEVE
or stop asthma symptoms by quickly opening the
airways and are very helpful during an asthma
episode.
In long-acting forms, bronchodilators provide
CONTROL of asthma symptoms and prevent
asthma episodes.
Treatment

Asthma drugs can be taken in a variety of

ways.
 Inhaling the Medications - by using a
metered dose inhaler, dry powder
inhaler or nebulizer - is one way of
taking asthma medicines. Eg
salbutamol, vintolin.
 Oral Medicines pills or liquids you
swallow may also be prescribed.
Eg. Leukotriene receptor antagonists
(LTRAs)
 Monitoring the effectiveness of treatment

Monitoring of bronchial asthma should live up to the expectations

of treatment for the individual patients.
 The desired treatment outcomes are generally regarded as
elimination of symptoms, improvement and hopefully
normalization of lung function to the individual’s personal best.
 Reducing and eliminating the occurrence of exacerbations and
achievement of the above with little or no adverse effects from
intervention and treatments.
 cont’.
 Good patient education enables the patient to understand
the asthmatic disease process, and what causes
worsening, stabilization and improvements of the
disease.
 A patient must have a thorough understanding of the
treatment offered. The patient must be able to assess
symptoms and have proper equipment
for measuring lung function at home if possible
 Cont.
 Behavior change: the patient’s way of life, including smoking
cessation and allergen avoidance measures can greatly help.

 The health professional taking care of the patient must be able to

assess the disease severity, investigate the cause of the disease, and
offer guidance and optimum treatment to the patient.

 Inadequateassessment of the severity of asthma may be a cause of

under-treatment
 Monitoring the effectiveness of treatment in CHILDREN
Proper assessment should include not only evaluation of objective
measurements, such as pulmonary function, but also the effect of
symptoms on the quality of the child’s life. It is, therefore, important
to:
(i) promote the continuance of education of primary care physicians
(ii) encourage appropriate referrals to qualified specialists
(iii) enhance education of patients and parents; and
(iv) plan the management of asthma from the perspective of the
‘whole patient’ s
Nursing Assessment;
Assessment of a patient with asthma includes the following:
Assess the patient’s respiratory status by monitoring the
severity of the symptoms.
Assess for breath sounds.
Assess the patient’s peak flow.
Assess the level of oxygen saturation through the pulse
oximeter.
Monitor the patient’s vital signs.
Nursing Diagnosis
Based on the data gathered, the nursing
diagnosis appropriate for the patient with
asthma include:
Ineffective airway clearance related to
increased production of mucus and
bronchospasm.
Impaired gas exchange related to
altered delivery of inspired O2.
Anxiety related to perceived threat of
death.
 Nursing Care Planning & Goals
To achieve success in the treatment of a patient with asthma, the following goals
should be applied:
 Maintenance of airway patency.
 Expectoration of secretions.
 Demonstration of absence/reduction of congestion with breath sounds clear,
respirations noiseless, improved oxygen exchange.
 Verbalization of understanding of causes and therapeutic management regimen.
 Demonstration of behaviors to improve or maintain clear airway.
 Identificationof potential complications and how to initiate appropriate
preventive or corrective actions.
 Nursing Interventions
The nurse generally performs the following interventions:
 Assess History.Obtain a history of allergic reactions to medications before administering
medications.
 Assess Respiratory Status. Assess the patient’s respiratory status by monitoring the severity
of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
 Assess Medications. Identify medications that the patient is currently taking. Administer
medications as prescribed and monitor the patient’s responses to those medications;
medications may include an antibiotic if the patient has an underlying respiratory infection.
 Pharmacologic Therapy. Administer medications as prescribed and monitor patient’s
responses to medications.
 Fluid Therapy. Administer fluids if the patient is dehydrated.
 Evaluation
To determine the effectiveness of the plan of care, evaluation must be performed.
The following must be evaluated:
 Maintenance of airway patency.
 Expectoration or clearance of secretions.
 Absence /reduction of congestion with breath sound clear, noiseless respirations,
and improved oxygen exchange.
 Verbalized understanding of causes and therapeutic management regimen.
 Demonstrated behaviors to improve or maintain clear airway.
 Evaluation con’t
 Absence /reduction of congestion with breath sound clear, noiseless
respirations, and improved oxygen exchange.
 Verbalized understanding of causes and therapeutic management regimen.
 Demonstrated behaviors to improve or maintain clear airway.
 Identified potential complications and how to initiate appropriate preventive
or corrective actions.
 Identified potential complications and how to initiate appropriate preventive
or corrective actions.
 Discharge and Home Care Guidelines
A major challenge is to implement basic asthma management principles at the home and
community level.
 Collaboration. The complex therapy of treating asthma at home needs collaboration
between the patient and the health care provider to determine the desired outcomes and to
formulate a plan to achieve those outcomes.

 Health Education. Patient teaching is a critical component of care for patients with

asthma. Teach patient and family about asthma (chronic inflammatory), purpose and action
of medications, triggers to avoid and how to do so, and proper inhalation
technique. Instruct patient and family about peak-flow monitoring. Obtain current
educational materials for the patient based on the patient’s diagnosis, causative factors,
educational level, and cultural background
 Cont.
 Compliance To Therapy. Nurses should emphasize adherence to the
prescribed therapy, preventive measures, and the need to keep follow-up
appointments with health care providers. Teach patient how to implement an
action plan and how and when to seek assistance.

 Home visits. Home visits by the nurse to assess the home environment for
allergens may be indicated for patients with recurrent exacerbations.
 Documentation Guidelines
Documentation is a necessary part of the nursing care provided, and the following data must be documented:
 Related factors for individual client.
 Breath sounds, presence and character of secretions, and use of accessory muscles for breathing.
 Character of cough and sputum.
 Respiratory rate, pulse oximetry/o2 saturation, and vital signs.
 Plan of care and who is involved in planning.
 Teaching plan.
 Client’s response to interventions, teaching, and actions performed.
 Use of respiratory devices/airway adjuncts.
 Response to medications administered.
 Attainment or progress towards desired outcomes.
 Modifications to the plan of care.
Question
References

 https://www.who.int/respiratory/asthma/definition/en/
 Holgate and Polosa 2006
 Global, regional, and national incidence, prevalence, and years lived with
disability for 328 diseases and injuries for 195 countries, 1990–2016: a
systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;
390: 1211–59.
 Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by
Region, 2000-2016. Geneva, World Health Organization; 2018.
 Global Health Estimates 2016: Disease burden by Cause, Age, Sex, by Country
and by Region, 2000-2016. Geneva, World Health Organization; 2018
 VIDOES ON Bronchial Asthma
 https://www.youtube.com/watch?v=ozyruyITxKg
 https://www.youtube.com/watch?v=NNfx27io8-k
 https://www.youtube.com/watch?v=PzfLDi-sL3w
 https://www.youtube.com/watch?v=uNfr45tfNnY
 https://www.youtube.com/watch?v=VSsnjQZB8Qk
 https://www.youtube.com/watch?v=H6aC6ayHn6Y
 https://www.youtube.com/watch?v=6feGnZjxyHo
 https://www.youtube.com/watch?v=EK8nzKzdnIM
 https://www.youtube.com/watch?v=a7MWzOvyeBw
 https://www.youtube.com/watch?v=zbL34Am30WM