An Introduction to Asthma

1. An Introduction to Asthma • By: Deepak Kapoor Nursing Curriculum Join us on Facebook and explore relevant information & latest trends in nursing. Click below for connecting Redefining the nursing with new outlook

2. Asthma is a chronic disease that affects your airways. It is characterized by inflammation of airways called bronchial tube. These airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night. When your asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that your vital organs do not get enough oxygen. People can die from severe asthma attacks. Asthma- Meaning & Definition It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day. By:WHO Video

3. Allergic Asthma • Non-Allergic Asthma • Nocturnal Asthma • Occupational asthma • Child-onset Asthma • Adult-onset Asthma Types of Asthma • Cough-variant Asthma • Mixed Asthma • Seasonal Asthma

4. Allergic Asthma This type of asthma is the most common among all the other types. Statistics show that kids are more prone to allergic asthma with 90% having the disorder. Allergens such as molds, pollen and mites are the most common culprit of allergic asthma. Inhaling strong fumes, dust, smoke, perfumes or colognes can actually make it poorer. Types of Asthma

5. Non Allergic Asthma Non-Allergic (intrinsic) asthma is triggered by factors not related to allergies. Like allergic asthma, non-allergic asthma is characterized by airway obstruction and inflammation that is at least partially reversible with medication, however symptoms in this type of asthma are NOT associated with an allergic reaction. Many of the symptoms of allergic and non-allergic asthma are the same, but non-allergic asthma is triggered by other factors such as anxiety, stress, exercise, cold air, dry air, hyperventilation, smoke, viruses or other irritants. In non-allergic asthma, the immune system is not involved in the reaction. Types of Asthma Nocturnal Asthma From the name itself, it is quite obvious that this type has something to do with sleep. It actually has something to do with sleep because it disturbs or disrupts the sleeper's sleep during night. They usually waken in the middle of the night by very dry coughs. Tightening of the chest is one of the very first symptoms of nocturnal asthma, followed by a series of uncontrollable, dry coughs

6. Occupational Asthma Again, the background and cause of this type of asthma can already be guessed or determined from the name itself. This kind is just like any other kind where the only thing that makes it distinct from others is that it is acquired in the place where an individual is working. Perhaps one of the most common occupations that induces asthma are teaching (chalk dust exposure), factory workers (exposure to dust and other powders), painters and construction workers (exposure to paint and other fumes), etc. Types of Asthma Child-onset AsthmaThis usually occurs when children are exposed to certain allergens such as dust mites, fungi, animal proteins, and other potential allergens. When a young child or infant wheezes during viral infections, it may be a hint that asthma may be brewing around the corner as they grow older.

7. Adult-onset AsthmaIt can easily be described as a type of asthma that develops during adulthood. It may be allergic, non-allergic, occupational, mixed, seasonal or nocturnal. The distinct characteristic is that it occurs in adulthood. Cough-variant Asthma This kind of asthma may be a bit difficult to diagnose since it can be confused with other kinds of cough that may be related to chronic bronchitis, sinus diseases or post nasal drips due to hay fever. It would usually take a lot of tests and check-ups before the doctor can make a proper diagnosis. Types of Asthma Mixed Asthma This is a mixture of extrinsic and intrinsic asthma. This is a more serious kind since the sufferer must be vigilant to both extrinsic and intrinsic factors that can trigger asthma attacks.

8. Seasonal Asthma From the name itself, seasonal asthma only occurs during certain seasons wherein the pollens or other allergens seem to be more present than any other season. For example, an individual is quite healthy all year round except during Diwali season, when firecrackers are more common. The dust and smoke emitted by firecrackers may be the triggers for the asthma attack. Types of Asthma

9. Triggers vary from person to person, so you will have to figure out which of the potential triggers are problems and which are not. The muscles around the airways of your lungs squeeze together or tighten. This tightening is often called "bronchoconstriction," and it can make it hard for you to breathe. Common asthma triggers include: • Animals (pet hair or dander) • Dust • Changes in weather (most often cold weather) • Chemicals in the air or in food • Exercise • Mold • Pollen • Respiratory infections, such as the common cold • Strong emotions (stress) • Tobacco smoke Asthma –Etiology/ Triggers

10. Recurrent attacks of wheezing, dyspnoea, and, in some cases, cough with tenacious mucoid sputum • Paroxysm begins with a feeling of chest tightness • Feeling little comfort from sitting upright of leaning forward during the attack, and muscle pain of the lower chest following an attack • Short and gasping inspiration and prolonged expiration • Wheezing is often audible without any aid. • Shortness of breath, wheeze, cough and tightness around the chest appearing generally several hours after exposure to the offending agents in occupational asthma • Nothing abnormal in chest X-rays except emphysema in long-standing cases Asthma- Clinical Manifestation

11. Peak Flow is probably the simplest test that you can use to see how well your asthma is doing . • Spirometry is slightly more complicated than peak flow in that it is usually done in your doctors office and measures both how much and how quickly air moves out of your lungs. It is important in both the diagnosis and management of asthma over time. • Complete Pulmonary Function Testing-Your asthma care provider may want to determine your lung volumes and diffusing capacity. This is often done if your asthma diagnosis is unclear. The test requires you to sit inside a special box that helps determine how much air you breathe in and out. • Chest X-Ray-A chest x-ray is a test commonly preformed for patients who wheeze. An asthma care provider will usually order one to make sure there is not some other condition that may be causing your symptoms like a lung infection. Asthma- Diagnosis

12. Bronchoprovocation Challenge Testing-When your asthma provider orders a bronchoprovocation test, you will inhale a specific substance through a nebulizer, often methacholine or histamine. This is done to see if your lungs become irritated, hyperresponsive, and lead to the development of asthma symptoms. The test has a high negative predictive value. This means that if the test is negative it is unlikely you have asthma. • Pulse Oximetry-Pulse oximetry is a non-invasive way to measure oxygenation of blood or how well oxygen is being exchanged between the lungs and the blood. A sensor is placed on the fingertip or other thin part of the body with blood vessels close to the skin. The sensor measures changes in wavelengths of light and is able to estimate oxygenation in the blood. • Arterial Blood Gas (ABG)-An arterial blood gas (ABG) is an arterial blood sample used to determine how well blood is oxygenated -- a marker for oxygen exchange between the lungs and the blood. Commonly, a blood sample will be obtained from one of the arteries near your wrist. This test may likely be preformed during an acute asthma exacerbation and is more reliable than pulse oximetry. Asthma- Diagnosis

13. Allergy Testing-The relationship between allergies and asthma has been known for a long time. Allergens you normally breathe in can increase the inflammatory reaction and hyper responsiveness in your lungs. However, your doctor cannot reliably determine if a particular allergen is responsible for your symptoms on clinical grounds alone. Because of this, your asthma care provider may recommend allergy testing. Not all asthmatics are tested. But if you have persistent asthma, your asthma care provider will probably recommend testing. Asthma- Diagnosis

14. Anti-inflammatories • These are the most important medicines for most people with asthma. Anti-inflammatory medications reduce swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers. These medications need to be taken daily and may need to be taken for several weeks before they will begin to control asthma. Anti-inflammatories lead to fewer asthma symptoms, better airflow, less-sensitive airways, less airway damage and fewer asthma episodes. If taken every day, they control or prevent asthma symptoms. • Bronchodilators • These medications relax the muscle bands that tighten around the airways. This action rapidly 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, the mucus moves more freely and can be coughed out more easily. In short-acting forms, bronchodilators relieve or stop asthma symptoms and are very helpful during an asthma episode. Asthma- Medical Management Drugs

15. Drug names: Generic name (Brand name) • Beclomethasone (Qvar®) • Budesonide (Pulmicort®; Symbicort® – combination budesonide and formoterol- a long-acting beta2-agonist) • Flunisolide (Aerobid®) • Fluticasone (Flovent® HFA; Advair® – combination fluticasone and salmeterol -a long acting beta2-agonist) • Mometasone (Asmanex®) • Triamcinolone (Azmacort®) • Prednisone (Deltasone®) • Prednisolone (Prelone®, Pediapred®, Orapred®) Cromolyn sodium (Intal®) • Nedocromil sodium (Tilade®) Asthma- Medical Management Back

16. Maintain respiratory function and relieve bronchoconstriction while allowing mucus plug expulsion. • Control exercise-induced asthma by having the patient sit down, rest, and use diaphragmatic and pulse-lip breathing until shortness of breath subsides. • Supervise the patient’s drug regimen. • Demonstrate the proper use of metered doe inhaler properly. • Reassure the patient during an asthma attack and stay with him. • Place the patient in semi-fowler position and encourage diaphragmatic breathing. • Assist him to relax as much as possible. • As ordered, administer oxygen by nasal cannulatoease breathing and to increase arterial oxygen saturation during an acute asthma attack. • Adjust oxygen according to the patient’s vital functions and ABG measurements. Asthma- Nursing Management

17. Administer drugs and I.V. fluids as ordered. • Combat dehydration with I.V. fluids until the patient can tolerate oral fluids, which will help loosen secretions. • Encourage the patient to express his fears and concerns about his illness. • Encourage the patient to identify and comply with care measures and activities that promote relaxation. Asthma- Nursing Management

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