Bronchial Asthma

Bronchial Asthma

Definition :-

          It is a chronic inflammatory disorder of the air ways in which the inflammation causes varying degree of obstruction in airways.

          Inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and persistent cough in particularly in night and early morning.

Classification :

1. Mild Intermittent.

2. Mild persist.

3. Moderate persist.

4. Severe persist.

• Mild Intermittent : 

                            Symptoms no more frequently than twice weekly.

• Mild persist :

                           Symptoms more frequent than twice weekly but less than once a day.

• Moderate persist :

                           Symptoms persist daily.

• Severe persist : 

                           Continuous symptoms with linked physical activity. 

Ethiology : -

• Allergens : Exaggerated response of Ig E
  Ex : Pollens, Dust, Grass, Animal dandruff etc. 

• Exercise induced asthma ( EIA )
• Respiratory infections.
• Food additives
• Nose and sinus problem
• Drugs
• Emotional Stress
• GERD

 Allergens : 

          In some persons, ie asthma an exaggerated Ig E response to certain allergens occurs.

Ex : Pollens, Dust, Grass, Animal Dust.

Exercised Induced Asthma :

          Asthma is induced during the physical exertion is called as exercise induced asthma ( EIA ).

          It will occur after several minutes of vigorous exercises.

Ex : Jagging, walking, Climbing slides.

Food additives : 

           Such as tartazine ( yellow dye ), Sulfites ( Bisulfites & metabolo bisulfites ), food preservatives in bear, wine etc.

Nose and Sinus Problems :

          Rhinitis, Nasal polyps, Sinusitis. 

Drugs :

          Tab : Aspirin & NSAIDS,

           Beta adrenergic blockers ( Propanol )

          It may cause asthma because they inhibit adrenergic stimulation of bronchioles and prevents the broncho dilation.
 

Emotional Stress :

          Psychological / emotional stress will also cause asthma.

GERD :

           The exact mechanism for asthma is not known in patients with hiatal hernia, excessive stress, and prior History of reflexes or ulcer diseases may have the mild reflex as asthma triggers.

Pathophysiology :

Clinical Manifestations:-

• Wheezing
• Breath lessness
• Chest tightness
• Cough
• Expiration : Prolonged ( Normal : 1: 2 )
       Expiration may be prolonged ie, instead of normal inspiratory : expiratory ratio of 1:2,
  it may prolonged to 1 : 3 or 1 : 4 during the expiration. The bronchi oles will consist.
• Bronchial spasm
• Edema and Mucus in bronchi oles.
• Airways become narrow than the usual due to the constriction of bronchi oles.
• Air trapping.
• Hyperventilation.
• Silent Chest ( Diminished breath sounds )
• Cough.
• Secretions may be thick.
• Gelatinous mucous.
• Hypoxemia.
• Restlessness.
• Increased anxiety.
• Inappropriate behavior.
• Increased pulse and B P
• Pulse paradoxes ( Drop of systolic BP in inspiration )
• Respiratious increases greater than 30 breaths/min.

Diagnositc Studies :

• A detailed history may indicate previous attacks of precipitating factors.
• PHYSICAL EXAMINATION : It reveal the previous attacks of exposure
  to allergens will be obtained.

• Pulmonary Function Test.
• Chest X-ray : Hyperventilation.
• Measurements of ABG analysis.
            ABG indicates respiratory Alkalosis, Hypercapnia ( Increased Co2 level ) and
  respiration and metabolic acidosis indicates severe disease.
• Allergy skin testing : It will determines sensitivity to specific allergens.
• Complete Blood Count ( CBP ).
• Serum electrolytes.

Medical Management :-

NAEPP : National Asthma Education & Prevention Programme

                Categories  medications into two classification.

          i) Long term control medications.

         ii) Quick relief medication.

i) Long term : To active and maintain control of persistent asthma.

ii) Quick relief : To treat the symptoms at exaversation.

Classification of Bronchial Asthma Drugs 

Bronchial Asthma Drugus.

Nursing Management :-

• Health Promotion
• Active intervention
• Nursing Assessment.
• Subjective Date :
       - Important Health information.
       - Previous Medications.
       - History of exercise.
       - Rest & Sleep patterns.
       - Food Additives.
       - Allergens.
       - Hereditary Disorders.
•  
• Obejective Date :
       - Assess the general Integument, Respiration, CVS, Possible findings,
         Like : Abnormal ABG, Decreased Spo2 Levels.

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