Understanding Asthma: Causes, Risks & Symptoms

Definition

• Asthma is a condition causing inflamed, narrow airways that swell and produce extra mucus, leading to breathing difficulty.
• Asthma severity varies from minor to life threatening.

Normal Bronchial Tube Vs Inflamed Bronchial Tube of An Asthmatic

• Normal bronchial tube has relaxed smooth muscles and alveoli
• Inflamed bronchial tube has tightened smooth muscles, mucus, and swelling.

Risk Factors

• Family history
• History of allergens
• Exposure to passive smoking
• Obesity
• Urban living
• Low birth weight
• Regular use of NSAIDs

Etiology - Factors Responsible

• Environmental factors such as temperature changes, specifically cold air.
• Humidity changes, specifically dry air.
• Atmospheric pollutants like cigarette smoke, industrial smoke, ozone, sulphur dioxide, and formaldehyde.
• Allergen inhalation from food treated with sulphate, beer, and wine.
• Stress and emotional upset.
• Medications such as NSAIDs and β-blockers.
• Strong odours and perfumes.

Types of Asthma

• Allergic Asthma (Extrinsic Asthma) symptoms are induced by a hyper immune response to specific allergens inhalation.
• Non-Allergic Asthma (Intrinsic Asthma) triggers include non-allergic airway irritants like air pollution, cold, heat, weather changes, fumes, wood or cigarette smoke, room deodorants, and household cleaning products.
• Non-Allergic Asthma (Intrinsic Asthma) triggers include perfumes, respiratory tract infections, temperature changes, stress/emotional upsets, physical exertion, exercise, drugs like aspirin/NSAIDs, and food preservatives.
• Mixed Asthma features characteristics from both allergic and non-allergic asthma and represents the most common form of asthma.
• Cough-Variant Asthma does not present classic asthma symptoms like wheezing and shortness of breath.
• Exercise-Induced Asthma affects individuals during or after physical activity, and may arise in those insensitive to typical asthma triggers like dust, pollen, or pet dander.
• Nocturnal Asthma involves asthma symptoms that worsen at night, but can also experience symptoms anytime of the day.
• Occupational Asthma is induced by workplace triggers, including dusts, dyes, gases, fumes, animal proteins, and rubber latex, prevalent in manufacturing, textiles, farming, and woodworking.

Pathophysiology

• Asthma is triggered by etiological factors like allergens, air pollutants, and occupational exposure
• Mast cell degranulation follows.
• This leads to airway inflammation.
• This leads to airway muscle constriction.
• This results in narrow breathing passages.
• This results in bronchospasm.
• This results in airway obstruction.

Clinical Manifestations

• Wheezing
• Shortness of breath
• Chest tightness
• Pain
• Cough
• Prolonged expiration
• Anxiety
• Tachypnea
• Suffocation
• Confusion

Diagnostic Evaluation

• History collection
• Physical examination
• Spirometry
• ABG shows hypoxemia and increased Pco2/acidosis.
• Chest X-ray shows hyperinflation of lung.
• Auscultation of breath sounds.

Complications

• Respiratory failure
• Pneumonia
• Cardiac arrest
• Status Asthmaticus
• Atelectasis

Medical Management

• Bronchodilators (Beta-agonists) widen airways relaxing bronchial smooth muscle by stimulating beta-receptors, like Salbutamol, Albuterol, and Formoterol.
• Xanthine derivatives have a diuretic effect and relaxes smooth muscles, especially of bronchi, like Throphylline, Aminophylline, and Deriphylline.
• Anticholinergics’ actions include relaxation of smooth muscle and decreased mucus secretion, like Ipratropium and Atropine sulphate
• Corticosteroids are anti-inflammatory and anti-allergic, such as Methylprednisolone, Prednisolone, and Betamethasone.
• Leukotriene receptor antagonists prevent the action of leukotriene by blocking their receptors on cell membranes, like Montelukast and Zafirlukast.
• Mast cell stabilizers stop the activities of mast cells, like Cromolyn sodium.

Health Education

• Avoid allergens
• Avoid extreme cold weather
• Avoid mouth breathing
• Avoid contact with viral infectious people
• Avoid smoking (active/passive)

Nursing Management - Assessment

• Assess clinical signs of patient's airway distress.
• Provide emergency management for acute airway distress.
• Take a patient history.
• Collect knowledge about the allergic reaction in different environmental conditions.
• Ask about the patient's workplace.
• Consider allergic modifications and lifestyle factors.

Nursing Management - Diagnosis 01

• Nursing diagnosis: Ineffective airway clearance related to increased production of secretions and bronchospasm evidenced by chest pain.
• Goal: Clear patient airway.
• Interventions:
  • Assess patient vitals.
  • Administer airway if required.
  • Assess breathing pattern for shortness of breath, pursed-lip breathing, and nasal flaring.
  • Give oxygen by face mask as ordered.
  • Give nebulization using asthalin and impravent solution.
• Evaluation: patient airway is cleared.

Nursing Management - Diagnosis 02

• Nursing diagnosis: Impaired Gas Exchange related to air trapping evidenced by shortness of breathing.
• Goal: Maintain Oxygen saturation >90%.
• Interventions:
  • Monitor pulse oximetry for oxygen saturation levels.
  • Assist the client to cough effectively.
  • Encourage oral fluids to thin secretions and replace fluids lost through rapid respiration.
  • Do frequent position changes
• Evaluation: Patient oxygen saturation level is maintained.

Nursing Management - Diagnosis 03

• Nursing Diagnosis 3: Anxiety related to hospitalization as evidenced by patient asking many questions.
• Goal: reduce patient's anxiety level.
• Intervention:
  • Assess the anxious level of patient
  • Educate the patient regarding treatment regimen
  • Provide psychological support to the patient
  • Allow family members to spare time with patient
• Evaluation: patient anxiety level is reduced.

Nursing Management - Diagnosis 04

• Nursing Diagnosis 4: Knowledge deficit related to treatment regimen as evidenced by patient asking many questions.
• Goal: improve knowledge level of patient.
• Intervention:
  • Assess the anxious level of patient
  • Educate the patient regarding treatment regimen
  • Provide psychological support to the patient
  • Educate dos and don'ts regarding the disease condition.
• Evaluation: patient knowledge regarding the disease condition is improved.