Asthma

by Sejane Mapaseka
o Objectives
At the end of this presentation learners should
be able to:
-define asthma
-describe causes and predisposing factors of
asthma
-list signs and symptoms of asthma
-outline diagnostic tests
-explain basic management of asthma
-explain pharmacological treatment of asthma
Asthma
It is the common inflammatory disease of the
airways associated with episode of reversible
over reactivity of the airway smooth muscle.
How asthma occur
• the mucus membrane and muscle layers of the bronchi become
thickened.
• The mucus glands enlarge, reducing airflow in the lower respiratory
tract
• The wall swell and thicken with inflammatory exudate and an influx of
inflammatory cells especially eosinophils.
• During an asthma attack, spasmodic contraction of bronchial muscles
(bronchospasm)constricts the airway and there is excessive secretion
of thick sticky mucus which further narrows the airway.
Cont.…

• The duration of attacks usually varies from a few minutes to hours

• In severe acute attacks the bronchi may be obstructed by mucus
plugs, blocking airflow and leading to acute respiratory failure,
hypoxia and possibly death.
Signs and symptoms of asthma
• Cough
• Chest tightness
• Wheezing
• dyspnoea
Clinical categories of asthma
• There are two clinical categories of asthma which generally give rise
to identical symptoms and are treated the same way
• They are ; atopic asthma and non atopic asthma
Atopic ( childhood-onset extrinsic) asthma

• This occurs in children and young adults who have atopic (type 1)
hypersensitivity to foreign protein e.g pollen ,dust containing mites
from carpets ,feather pillows , animal dander or fungi
• a history of infantile eczema or food allergies is common and there
are often close family members with a history of allergy
• As In hay fever ,antigens (allergens) are inhaled and absorbed by the
bronchial mucosa
cont…
• This stimulates the production of immunoglobulin E (igE) antibodies ,
which bind to the surface of mast cells and basophils round the
bronchial blood vessels
• When the allergen is encountered again , the antigen or antibody
reaction results in the release of histamine and other related
substances the stimulate mucus secretion and muscle contraction ,
narrowing the airways
• Attacks tend to become less frequent and less severe with age
Non-atopic ( adults-onset ,intrinsic )asthma
• This type occurs later in adults life and there is no history of childhood
allergic reactions . It can be associated with chronic inflammation of
the upper respiratory track , e.g chronic bronchitis or nasal polyps
• Other triggers factors include exercise and occupation exposure ,.s.g
inhaled paint fumes . Aspirin triggers an asthmatic reaction in some
people
Cont…
• Attacks tend to increase in severity over time and lung damage may
be irreversible
• Eventually impaired lung ventilation leads to hypoxia pulmonary
hypertension and right-sided heart failure
Causes of asthma
• It isn’t clear why some people get asthma and others don’t but its
probably due to a combination of environment and genetic
(inherited)factors.
• There are some predisposing factors which are:
• Allergy- chronic exposure to airway irritants or allergies increasing the
risk of asthma e.g seasonal (grass, tree)
• Airway irritants e.g air pollutants, cold ,heat, weather changes, strong
odours, smoke
• Food like shellfish, nuts
• Emotional stress
Cont…
• Medications including beta blockers, asprin, ibuprofen
• Viral respiratory tract infection like common cold
• Gastroesophageal reflux disease(GERD)
Risk factors of asthma
• Having a good relative with asthma
• Having another allergic condition such as atopic dermatitis or allergic
rhinitis(hay fever)
• Being overweight
• Being a smoker
• Explosure to second hand smoke
• Having a mother who smocked while pregnancy
complications
• Status asthmatics
• Respiratory failure
• Pneumonia
• Atelectasis
• Side effects from long term use of medication used to stabilize severe
asthma
Diagnostic tests
• Physical exam
• To rule put other possible condition –such as a respiratory infection or
chronic obstructive pulmonary disease (COPD), the doctor will do a
physical exam and ask questions about the signs and symptoms and
about any other health problems
Basic nursing management
• The nurse should obtain a history of allergic reactions to medications
before administering medications
• The nurse should identify medications the patient is taking
• Administering medication as prescribed and monitor the patient’s
responses to those medications
• Administer fluids if the patient is dehydrated
• Administering a bronchodilator such as inhaler to help open the
airways and also hydration to keep the airways moist
Cont…
• Educate patient on ways to slow their breathing and stay calm
• Use stethoscope to listen to a patient’s breathing and the severity of
the wheezing
Phamacological treatment
In adult
Inhaled salbutamol(short acting) 6hourly 200mcg
High dose steroids: belcomethason inhaler 200-400 12 hourly for a
month
Oral steroids: prednisone 10mg orally 8hourly for 5 days
In children
Inhaler salbutamol( short acting) hourly 200mcg
Low dose steroid: belcomethasone inhaler 100-200 12hourly
High dose steroid: beclomethasone 400mcg 12hourly
Salbutamol indications
• Salbutamol is indicated as a bronchodilator in the treatment of
bronchospasm associated with asthma, emphysema and chronic
bronchitis
• Contraindications
• Salbutamol should not be taken together with beta-blocking agents.
Cont…
• Salbutamol is contraindicated in hyperthyroidism and cardiac disease.
• Further, safety in pregnant and lactating women Has not been
established use of salbutamol is contraindicated in these population
• Salbutamol is not indicated for prevention of premature labour’s
associated with toxaemia of pregnancy or after partum haemorrhage
nor should it be used for threatened arbortion during first and second
trimesters of pregnancy.
Site effects of salbutamol
• It may cause fine tremor of skeletal muscle
• Anxiety, fever, restless, insomnia confusion, irritability, weakness,
psychotic states, nausea and vomiting may occur due to the central
effects of salbutamol.
• Difficult in micturition an urinary retention, dyspnoea, altered
metabolism, sweating
Indications of beclate 50 HFG (belcomethasone inhaler)
• Be late HFG inhalers are indicated for the prophylactic treatment of
bronchospasm, in the following groups of patients with asthma.
• Patients who are expected to be on term steroid maintenance
therapy.
• Patient with severe asthma who are dependent on systemic
corticosteroids, or those patients who are receiving intermittent
courses of oral steroid
Contraindications of beclate 50 HFA
• Acute status asthmatic
• Special care is necessary in patients with active or quiescent
pulmonary tuberculosis
• Safety of bleclate HFA in pregnancy has not been established.
Side effects
• Metabolic and nutritional disoders
-intolerance to adrenocorticoids
-skin disorder
-hypersensitivity reactions ( including oedema of the eyes , face, lips)
Thank you.