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asth·ma

ˈazmə/
noun
1. a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty
in breathing. It usually results from an allergic reaction or other forms of hypersensitivity.

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This
can make breathing difficult and trigger coughing, wheezing and shortness of breath.

Asthma Symptoms
According to the leading experts in asthma, the symptoms of asthma and best treatment
for you or your child may be quite different than for someone else with asthma.

The most common symptom is wheezing. This is a scratchy or whistling sound when you
breathe. Other symptoms include:
• Shortness of breath
• Chest tightness or pain
• Chronic coughing
• Trouble sleeping due to coughing or wheezing

Asthma symptoms, also called asthma flare-ups or asthma attacks, are often caused by
allergies and exposure to allergens such as pet dander, dust mites, pollen or mold. Non -
allergic triggers include smoke, pollution or cold air or changes in weather.

Asthma symptoms may be worse during exercise, when you have a cold or during times of
high stress.

Children with asthma may show the same symptoms as adults with asthma: coughing,
wheezing and shortness of breath. In some children chronic cough may be the only
symptom.

Causes

Despite increased knowledge on the pathology of asthma and the development


of improved medications and management plans, the death rate from the
disease continues to rise. Here are some of the factors that influence the
development of asthma.
 Allergy. Allergy is the strongest predisposing factor for asthma.
 Chronic exposure to airway irritants. Irritants can be seasonal
(grass, tree, and weed pollens) or perennial (mold, dust, roaches,
animal dander).
 Exercise. Too much exercise can also cause asthma.
 Stress/ Emotional upset. This can trigger constriction of the airway
leading to asthma.
 Medications. Certain medications can trigger asthma.

Clinical Manifestations

The signs and symptoms of asthma can be easily identified, so once the
following symptoms are observed, a visit to the physician is necessary.

 Most common symptoms of asthma are cough (with or without mucus


production), dyspnea, and wheezing (first on expiration, then possibly
during inspiration as well).
 Cough. There are instances that cough is the only symptom.
 Dyspnea. General tightness may occur which leads to dyspnea.
 Wheezing. There may be wheezing, first on expiration, and then
possibly during inspiration as well.
 Asthma attacks frequently occur at night or in the early morning.
 An asthma exacerbation is frequently preceded by increasing
symptoms over days, but it may begin abruptly.
 Expiration requires effort and becomes prolonged.
 As exacerbation progresses, central cyanosis secondary to severe
hypoxia may occur.
 Additional symptoms, such as diaphoresis, tachycardia, and a widened
pulse pressure, may occur.
 Exercise-induced asthma: maximal symptoms during exercise, absence
of nocturnal symptoms, and sometimes only a description of a
“choking” sensation during exercise.
 A severe, continuous reaction, status asthmaticus, may occur. It is life-
threatening.
 Eczema, rashes, and temporary edema are allergic reactions that may
be noted with asthma.

Prevention

Patients with recurrent asthma should undergo tests to identify the substances
that precipitate the symptoms.

 Allergens. Allergens, either seasonal or perennial, can be prevented


through avoiding contact with them whenever possible.
 Knowledge. Knowledge is the key to quality asthma care.
 Evaluation. Evaluation of impairment and risk are key in the control.

Complications

Complications for asthma include the following:

 Status asthmaticus. Airway obstruction in status asthmaticus often


results in hypoxemia.
 Respiratory failure. Asthma, if left untreated, progresses to
respiratory failure.
 Pneumonia. Mucus that pools in the lungs and becomes infected can
lead to the development of pneumonia.

Assessment and Diagnostic Findings

To determine the diagnosis of asthma, the clinician must determine that


episodic symptoms of airway obstruction are present.
 Positive family history. Asthma is a hereditary disease, and can be
possibly acquired by any member of the family who has asthma within
their clan.
 Environmental factors. Seasonal changes, high pollen counts, mold,
pet dander, climate changes, and air pollution are primarily associated
with asthma.
 Comorbid conditions. Comorbid conditions that may accompany
asthma may include gastroeasophageal reflux, drug-induced asthma,
and allergic broncopulmonary aspergillosis.

Medical Management

Immediate intervention may be necessary, because continuing and progressive


dyspnea leads to increased anxiety, aggravating the situation.

Pharmacologic Therapy

 Short-acting beta2 –adrenergic agonists. These are the


medications of choice for relief of acute symptoms and prevention of
exercise-induced asthma.
 Anticholinergics. Anticholinergics inhibit muscarinic cholinergic
receptors and reduce intrinsic vagal tone of the airway.
 Corticosteroids. Corticosteroids are most effective in alleviating
symptoms, improving airway function, and decreasing peak flow
variability.
 Leukotriene modifiers. Anti Leukotrienes are potent
bronchoconstrictors that also dilate blood vessels and alter
permeability.
 Immunomodulators. Prevent binding of IgE to the high affinity
receptors of basophils and mast cells.

Nursing Care Planning & Goals


Main Article: 5 Bronchial Asthma Nursing Care Plans

To achieve success in the treatment of a patient with asthma, the following


goals should be applied:

 Maintenance of airway patency.


 Expectoration of secretions.
 Demonstration of absence/reduction of congestion with breath sounds
clear, respirations noiseless, improved oxygen exchange.
 Verbalization of understanding of causes and therapeutic management
regimen.
 Demonstration of behaviors to improve or maintain clear airway.
 Identification of potential complications and how to initiate appropriate
preventive or corrective actions.

Nursing Interventions

The nurse generally performs the following interventions:

 Assess history. Obtain a history of allergic reactions to medications


before administering medications.
 Assess respiratory status. Assess the patient’s respiratory status by
monitoring the severity of symptoms, breath sounds, peak flow, pulse
oximetry, and vital signs.
 Assess medications. Identify medications that the patient is currently
taking. Administer medications as prescribed and monitor the patient’s
responses to those medications; medications may include
an antibiotic if the patient has an underlying respiratory infection.
 Pharmacologic therapy. Administer medications as prescribed and
monitor patient’s responses to medications.
 Fluid therapy. Administer fluids if the patient is dehydrated.

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