Bronchial Asthma PDF

Bronchial asthma OBSTRUCTIVE RESPIRATORY DISORDERS Bronchial asthma Definition of bronchial asthma: Is a chronic inflammatory disease of the airways that causes airway hyper responsiveness, mucosal edema , and mucus production. Asthma differs from the COPD in that it is reversible...

Bronchial asthma OBSTRUCTIVE RESPIRATORY DISORDERS Bronchial asthma Definition of bronchial asthma: Is a chronic inflammatory disease of the airways that causes airway hyper responsiveness, mucosal edema , and mucus production. Asthma differs from the COPD in that it is reversible, either spontaneously or with treatment. Allergy is the strongest predisposing factor for asthma.  Obstructive Respiratory Disorders Bronchial asthma  Definition of status asthmatics: Status asthmatics are severe asthma that is unresponsive to conventional therapy and lasts longer than 24 hours. It may occur as a result of infection, anxiety, overuse of tranquilizer, dehydration increased adrenergic block and irritant.  PATHOPHYSIOLOGY OF ASTHMA - When airways are exposed to a certain allergen, the body deal with this allergen as a foreign invader that attacks the body. - The body's immune system responds by sending out antibodies (immunoglobulin E {IgE}) to fight the "invader." Each time the body is exposed to this certain antigen, these antibodies bind with antigens and cause the release of three chemicals; histamine, leukotrienes and eosinophils CONT. - Each chemical causes a different reaction in the airway: - Histamine: causes increased mucus production in the airway. - Leukotrienes: cause airway muscle constriction. Eosinophils: cause inflammation of the airway lining  Obstructive Respiratory Disorders Bronchial asthma **Causes of bronchial asthma** 1.Allergens : - Exogenous: Odors, temperature changes, dust, pollens ‫االتربه‬, and, Foods (egg, fish, milk), aspirin, and penicillin. - Endogenous: due to chronic infective process of larynx, tonsils, sinuses. 2.Infection: Chronic bronchitis with spasm which called asthmatic bronchitis. 3.Hormonal: pregnancy, menopause. 4.Hereditary: positive family history. 5.Psychogenic asthma: Common in female. RISK FACTORS FOR ASTHMA  Types of asthma 1. Allergic asthma is caused by specific allergens. 2. Idiopathic or non-allergic asthma is not related to specific allergens. - Factors such as respiratory infection, exercise, emotions and environmental pollutants may trigger an attack. - These attacks become more severe and frequent with time and can progress to chronic bronchitis and emphysema. 3.Mixed asthma is common form of asthma. - It has characteristic of both allergic and idiopathic forms. 1.  Obstructive Respiratory Disorders Bronchial asthma Clinical Classification of Asthma  Mild intermittent : Attacks occur 2 times per week or less  Mild persistent : Attacks occur more than 2 times per week  Moderate persistent : Attacks occur daily or almost daily and are severe enough to affect activity  Severe persistent : Attacks are very frequent and persist for a long period of time; attacks severely limit activity Obstructive Respiratory Disorders Bronchial asthma Clinical manifestations of asthma Early signs: 1. Cough. 2. Dyspnea. 3. Tachypnea. 4. Wheezing. Use accessory muscles of respiration CONT. Later signs: 1. Cyanosis secondary to severe hypoxia. 2. Symptoms of carbon dioxide retention e.g. sweating, tachycardia and widened pulse pressure. Eczema and urticaria  ASSESSMENT AND DIAGNOSTIC FINDINGS OF BRONCHIAL ASTHMA - A complete family, environmental, and occupational history is essential. - A positive family history and environmental factors, including seasonal changes, high pollen counts, climate changes (particularly cold air), and air pollution, are primarily associated with asthma.  CONT. - Sputum and blood tests may disclose eosinophilia (elevated levels of eosinophils). - Serum levels of immunoglobulin E may be elevated if allergy is present. - Arterial blood gas analysis and pulse oximetry reveal hypoxemia during acute attacks.  Obstructive Respiratory Disorders Bronchial asthma Pharmacologic therapy of bronchial asthma: The appropriate drug treatment regimen for asthma is based on the frequency and severity of the asthma attacks and may include the following: Two general classes of asthma medications are: - Long-acting medications to achieve and maintain control of persistent asthma. - Quick-relief medications for immediate treatment of asthma symptoms and exacerbations  Obstructive Respiratory Disorders Bronchial asthma Long-acting control medications: - Corticosteroids are the most potent and effective anti-inflammatory medications currently available. - They are broadly effective in alleviating symptoms, improving airway function, and decreasing peak flow variability. Initially, the inhaled form is used.  Obstructive Respiratory Disorders Bronchial asthma - Long-acting beta2-adrenergic agonists are used with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night. - Bronchodilators usually used in addition to inhaled corticosteroids, mainly for relief of night time asthma symptoms.  Obstructive Respiratory Disorders Bronchial asthma - Leukotriene modifiers (inhibitors) or anti leukotrienes are a new class of medications. - Antibiotics may also be given if an infectious process is suspected.  Obstructive Respiratory Disorders Bronchial asthma Quick relief medications - Short-acting beta-adrenergic agonists are the medications of choice for relieving acute symptoms and preventing exercise-induced asthma. They have a rapid onset of action. Anticholinergics (e.g., Ipratropium bromide [Atrovent]) may bring added benefit in severe exacerbations, but they are used more frequently in COPD patients  Obstructive Respiratory Disorders Bronchial asthma - Nebulized inhalers: Medication is inhaled by the patient.  [  Obstructive Respiratory Disorders Bronchial asthma Management of asthma exacerbation: Quick acting beta-adrenergic medications are first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medications. In some patients, oxygen supplementation may be required to relieve hypoxemia associated with a moderate to severe exacerbation.  Obstructive Respiratory Disorders Bronchial asthma Nursing management: The patient and family are often frightened and anxious because of the patient’s dyspnea. Thus, an important aspect of care is a calm approach. The nurse assesses the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.  Obstructive Respiratory Disorders Bronchial asthma The nurse obtains a history of allergic reactions to medications before administering medications and identifies the patient’s current use of medications. The nurse administers medications as prescribed and monitors the patient’s responses to those medications. Fluids may be administered if the patient is dehydrated, and antibiotic agents may be prescribed if the patient has chest infection. COMPLICATIONS OF BRONCHIAL ASTHMA: 1. Asthmatic bronchitis. 2. Emphysema (damage to alveoli in the lungs). 3. Spontaneous pneumothorax. 4. Anxiety. 5. Respiratory failure. 6. Atelectasis. 7. Pneumonia. 8. Pulmonary hypertension.  Obstructive Respiratory Disorders Feed back Which of the following is NOT a characteristic of asthma? a Increase in IgG immunoglobulins b Airway hyperresponsiveness c Infiltration of eosinophils into the airways d Increased mucus production. What is an asthma attack? A. When the lungs fill with water B. When airways tighten and the lungs don't get enough air C. When the heart beats too fast D. When the heart and lungs are working too hard  Obstructive Respiratory Disorders Emphysema The immediate response of asthma involves a mast cell degranulation b binding of antigen to IgE on macrophages c release of cytokines such as IL-13 d activation of cholinergic nerves. Long-acting β2-adrenoreptor agonists a work by increasing cGMP in airway smooth muscle b may become less efficacious due to tolerance after long-term use c can be used as the sole therapy in asthma d are the first choice for a reliever therapy. CONT. Chronic asthma is associated with a.activation of eosinophils b.activation of TH1 lymphocytes c.reduced function of goblet cells d. decreased permeability of submucosal capillaries. Which drug is the most commonly prescribed preventer therapy in asthma? a. β2-adrenoreceptor agonists b.Xanthines such as theophylline c.Muscarinic receptor antagonists d. Inhaled steroids.  CONT.  Asthma can be cured. Which of the following are potential asthma triggers? A. Dust mites and cockroaches B. Pets C. Secondhand smoke D. All of the above What can you do to reduce asthma triggers in your home? A. Clean up mold with soap and water B. Don’t smoke in the home C. Vacuum carpets, rugs and furniture often D. All of the above CONT. True or false Secondhand smoke increases the risk of preschool-aged children developing asthma. Asthma can be cured. Asthma is a chronic respiratory disease  Asthma can be cured, so it is not serious and nobody dies from it.  CONT. An asthma ______________ occurs when asthma symptoms become worse than usual. A. Crisis B. Attack C. Event D. All of the above What causes an asthma attack? A Allergens or the flu B Smoke C Exercise D All of the above