ASTHMA

Group 4
Berlin Devina Sriyadi
Dodik Firmansyah
Effi Muharyati
Eri Lalita Dewanti
Febrianti Eka Wulandari
Isnu Safitriana
Rifaldi Zulkarnaen
Vinda Astri Permatasari



Definition
Asthma is a chronic lung condition that affects
the airways. Asthma makes breathing difficult
because the airways become swollen, produce
too much mucus and the muscles around the
airways tighten.
Currently there is no cure for asthma, but it can
be controlled by routine medical care, which
should include a management plan developed by
a health care provider, medication(s), avoidance
of triggers, and good health habits.

Healthy People 2010, a national health
promotion and disease prevention initiative,
reports that nationwide, asthma is responsible
for 5,000 deaths and 134 million days of
restricted activity a year.

Air enters the respiratory system through the
nose and mouth. The air is humidified
(moistened), filtered and temperature
controlled in the nasal cavity and pharynx
(passageway from nasal cavity to larynx). The
air travels through the larynx (voice box), the
trachea (windpipe) and the airways (bronchial
tubes or bronchi).
Etiology
The risk factors of asthma include :
1. Genetics
2. Prenatal risk factors
3. Prenatal tobacco smoke
4. Diet and nutrition
5. Stress
6. Mode of delivery


Pathophisiology
Airway inflammation. In those with asthma, cells and tissues within the
airway are prone to inflammatory reactions against normally harmless
substances. This inflammation can cause swelling, mucous production and
lead to airway narrowing ( Lemanske ,2010).
Airway narrowing. Airway narrowing gives rise to asthma symptoms.
When the airways are exposed to substances that trigger a reaction,
immunoglobulin E (IgE) antibodies produced by B - cells help facilitate the
release of inflammatory mediators including histamine and leukotrienes
from mast cells. These mediators cause the airway smooth muscles to
contract or spasm, triggering airway narrowing (i.e., bronchoconstriction).
Sensory nerves in the muscles become more sensitized, contributing to
more bronchospasms (Miller, 2001).
Airway remodeling. Structural changes in bronchial tubes can occur with
chronic and uncontrolled asthma attacks. For instance, epithelial cells (the
layer of cells that line the airways and function as a barrier) can shed,
allowing irritants or allergens to further penetrate into the inner muscle
cells (James, 2005; Davies, 2009; Campbell, 1997).
Sensory nerves can also become exposed leading to reflex neural effects
on the airways (Kaufman, 2011).
Outlook (Prognosis) of asthma

There is no cure for asthma, although
symptoms sometimes improve over time.
With proper self-management and medical
treatment, most people with asthma can lead
normal lives.
Complications

The complications of asthma can be severe, and
may include:
Death
Decreased ability to exercise and take part in
other activities
Lack of sleep due to nighttime symptoms
Permanent changes in the function of the lungs
Persistent cough
Trouble breathing that requires breathing
assistance (ventilator)

Asthma Prevention

If you have asthma, you need to do what you can to
reduce your exposure to asthma triggers. Asthma
triggers can aggravate your asthma symptoms.
Identify triggers for asthma prevention
Avoid Smoke
Minimize exposure to allergens
Avoid colds
Allergy-proof your environment
Get a flu vaccine
Consider allergy shots (Immunotherapy)

Tests and diagnosis

Physical exam and interview
Test to measure lung function, may include:
Spirometry
Checking how much air you can exhale after a deep breath and how fast
you can breathe out.
Peak flow meter
Measures how hard you can breathe out.
Additional tests
Methacholine challenge (when inhaled, will cause mild constriction of
your airways)
Nitric oxide test (measures the amount of the nitric oxide gas, in your
breath)
Imaging tests (A chest X-ray and high-resolution computerized
tomography (CT) scan of your lungs and nose cavities (sinuses))
Allergy testing (by skin test or blood test)
Sputum eosinophils (present when symptoms develop and become
visible when stained with a rose-colored dye (eosin))
Provocative testing for exercise and cold-induced asthma



Nursing Management

The nurse assesses the patients respiratory status by monitoring the severity of
symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
The nurse obtains a history of allergic reactions to medications before
administering medications and identifies the patients current use of medications.
The nurse administers medications as prescribed and monitors the patients
responses to those medications.
Fluids may be administered if the patient is dehydrated, and antibiotic agents may
be prescribed if the patient has an underlying respiratory infection. Give patient 3
liters/day of fluid to help liquefy any secretions.
If the patient requires intubation because of acute respiratory failure, the nurse
assists with the intubation procedure, continues close monitoring of the patient,
and keeps the patient and family informed about procedures.
Administer supplemental oxygen to help meet bodys needs.
Identify and remove allergens and known triggers to avoid causing an asthma
attack.
Medical management (Pharmacologic
therapy)

Administer short-acting beta 2 -adrenergic drugs to bronchodilate: albuterol, pirbuterol,
metaproterenol, terbutaline, levalbuterol
Administer long-acting beta 2 -adrenergic drugs to manage symptoms day to day; keep airways
open, not for acute symptoms: salmeterol, formoterol
Administer leukotriene modulators to reduce local inflammatory response in lung to reduce
exacerbations; does not have immediate effect on symptoms: zafirlukast, zileuton, montelukast
Administer anticholinergic drugs ipratropium inhaler, tiotropium handihaler
Administer antacid, H2 blocker, or proton pump inhibitor to decrease the amount of acid in the
stomach, reducing the possibility of ulcers due to stress of disease or medication effects.
1. Antacids: aluminum hydroxide/magnesium hydroxide, calcium carbonate
2. H2 blockers: ranitidine, famotidine, nizatidine, cimetidine
3. Proton pump inhibitors: omeprazole, lansoprazole, esomeprazole, rabeprazole, pantoprazole
Administer mast cell stabilizer to retain an early component of the initial response to allergens,
which will prevent further reactions from occurring; this is not for acute symptoms. This is useful
for pretreatment for allergen exposure or chronic use to improve control of symptoms. cromolyn,
nedocromil
Administer steroids to decrease inflammation, which will help open airways; these are not for acute
symptoms : hydrocortisone, methylprednisolone intravenously, beclomethasone, triamcinolone,
fluticasone, budesonide, flunisolide, mometasone inhalers, prednisolone, prednisone orally
Administer methylxanthines to assist with bronchodilation, often used when other medications not
effective : aminophylline, theophylline.

References


American Academy of Allergy, Asthma and Immunology. 2002. Exercise-
Induced Asthma.
American Academy of Allergy, Asthma and Immunology. 2003. National
Allergy Bureau.
American Academy of Allergy, Asthma and Immunology. 2003. Tips to
Remember: Exercised-
Induced Asthma.
http://www.aaaai.org/nab.
http://www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stm
http://www.aaaai.org/patients/topicofthemonth/0202default.stm
http://www.webmd.com/asthma/guide/asthma-prevention
Smeltzer C.S and Bare Brenda. Brunner and Suddarths Textbook of Medical
Surgical Nursing 10
th

edition. Lippincott
Williams & Wilkins