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ASTHMA

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ASTHMA

 Definition:

• Asthma is a chronic inflammatory disorder of the airways . The chronic inflammation causes an increase in the airway hyper-responsiveness that leads to recurrent episodes of wheezing ,breathlessness , chest tightness and cough ,particularly at night or early in morning 



• ETIOLOGY :-

1. HOST FACTORS:-

• Genetic = genes predisposing to airway hyper responsiveness 

• Sex = more in male 2:1

2.ENVIRONMENTAL FACTORS:-

• A.  ALLERGENS:-

• Indoor – domestic mites , furred animal (dog, cat, mice), cockroaches ,fungi ,molds ,yeasts .

• Outdoor:- fungi ,molds ,pollens. 


• B.infections 

• C. Seasonal :- seasonal variation of asthma attacks in experienced by 35%of children. 

• D. Diet :- certain foods also trigger it.

• E. Respiratory infections 

• F. Psychology therapy 


• RISK FACTORS:-

• Hereditary 

• Allergens 

• Drug over dosage 

• Air pollutants 

• OCCUPATIONAL exposure 

• Psychological factors 

• Environmental factors 

• Upper respiratory tract infections 


• INCIDENCE :-

• Asthma affects an estimated 25,00,000 Indians every year and this number is likely to increase by 50% by the year 2016.

• Among adults women have a 30% greater prevalence of asthma than men

• It can occur in any age and in any sex

• 26 million are diagnosed with asthma every year 

• 10.6 million people are affected 

• Womens are increased risk of death compare to men 

• In India 4000-6000 are dying every year with asthma 


• TRIGGERING FACTORS:-

• Allergen inhalation:-

1. Animal

2. House dust     

3. Pollens

4. Cockroaches 


• AIR POLLUTANT :-

1. Exhaust fumes 

2. Oxidants              

3. Perfumes

4. Cigarette smoke 


• Viral upper respiratory infection.

• Sinusitis 

• Stress

• Exercise and cold dry air 

• DRUGS:-

1. Aspirin 

2. NSAIDs

3. Beta -adrenergic blockers 


• OCCUPATIONAL EXPOSURES:-

1. Metal salts.

2. Wood and vegetable dusts

3. Industrial chemicals and plastics. 


• FOOD ADDICTIVES

• GASTROESOPHAGEAL REFLUX DISEASE. 




• TYPES OF ASTHMA :-


1. ALLERGIC ASTHMA (extrinsic asthma).

• When the symptoms are induced by a hyper immune response to the inhalation of specific allergen.

• Type 1 hypersensitivity reaction is the basis of the igE.

2.NON - ALLERGIC ASTHMA (intrinsic asthma)

• This type of asthma is triggered by the presence of irritants in the air that are not related to allergies .

• This irritant stimulate parasympathetic nerve fibers in the airway causing bronch- constriction and inflammation. 


3.MIXED ASTHMA .

• Mixed asthma is the combination of both allergic and non - allergic asthma. 

• This is the most common form the asthma. 

4.  COUGH - VARIANT ASTHMA. 

• This does not have the classic symptoms of asthma - such as wheezing and shortness of breath .

• Instead it is characterized by one symptom , a persistent dry cough 


5. EXERCISE INDUCED ASTHMA:-

• Affects the person during or after physical activity  . 


6. NOCTURNAL ASTHMA:-

• Characterized by symptoms that gets worsen at night 

• Those who suffer from nocturnal asthma can be also experience SYMPTOMS nay time of day. 


7. OCCUPATIONAL ASTHMA :-

• Induced by triggers that exists in person 's work place including textiles ,farming and wood working


• CLINICAL MANIFESTATIONS :-

• Wheezing

• Cough 

• Dyspnoea 

• Nasal flaring 

• Hypoxia 

• Chest tightness 

• Expiration may be prolonged 

• Secretions may be white , thick ,tenacious, gelatinous mucus. 

• Deceased or absence of breath sounds called "SILENT CHEST"

• DIAGNOSTIC STUDIES:

• History 

• Physical examination 

• PFT

• Peak expiratory flow rate

• ABG or oximetry 

• Chest x-ray 

• Allergic skin testing 

•  Blood level of eosinophils and igE 


• COMPLICATIONS:-

• Rib fracture 

• Pneumonia 

• Status asthmatics 

• Atelectasis

• Pneumothorax


• MANAGEMENT OF ASTHMA:-

• A = Adrenergic 

• S = Steroids

• T= Theophylline 

• H= Hydration (Iv)

• M= Mask O2

• A= Anticholinergic 


• DRUG THERAPY:-

• Long term control medicines to achieve and maintain control of persistent asthma. 

• ANTI INFLAMMATORY DRUGS

• CORTICOSTEROIDS 

• BRONCHODILATORS 

• LONG ACTING BETA 2 ‐ ADRENERGIC AGONISTS 

• THEOPHYLINE

• Quick relief medicines to treat symptoms and exacerbations:-

• ANTICHOLINERGICS.

• CORTICOSTEROIDS 

• SHORT ACTING INHALED BETA 2 –ADRENERGIC 

• BRONCHODILATORS

• NURSING MANAGEMENT:-

• The management of asthma includes :-

• Education 

• Environment control 

• Evaluation 

• Emotional support 

• Regular follow-up 


• Lung function tests

1. Spirometry

2. Peak flow testing 


• Other tests: 

• Allergy testing

• Bronchoprovocation

• Tests to rule out other conditions with similar asthmatic symptoms (reflux disease, vocal cord dysfunction, sleep apnea)

• Chest X-ray

• Electrocardiogram (ECG)

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