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CHAPTER I

PRELIMINARY
A. BACKGROUND
From year to year the prevalence of asthma sufferers is increasing. In Indonesia,
research on schoolchildren aged 13-14 years using the ISAAC questionnaire (International
Study on Asthma and Allergy in Children) in 1995 showed that the prevalence of asthma was
still 2.1%, and the increase in 2003 was more than double that of 5, 2%. The increase in
prevalence in the UK and in Australia reaches 20-30%. National Heart, Lung and Blood
Institute reports that asthma affects 20 million Americans.
Asthma is proven to reduce the quality of life of sufferers. In a 2003 report in the
Journal of Allergy and Clinical Immunology, it was stated that of the 3,207 cases studied, 44-
51% had night coughs in the past month. In fact, 28.3% of sufferers claimed that they had
disturbed sleep at least once a week. Patients who claim to experience limitations in
recreation or exercise are 52.7%, 38% social activity, 44.1% physical activity, 37.1% lifestyle,
37.9% career choice, and 32.6% domestic work. Absence from school and work in the last 12
months was experienced by 36.5% of children and 26.5% of adults. In addition, the total
cost of treatment for asthma in the USA is around 10 billion dollars per year with the largest
expenditure on emergency rooms and hospital care. Therefore, effective therapy for people
with severe asthma is needed.
1.2 PURPOSE OBJECTIVES
1. To find out the anatomy of asthma
2. To know the physiology of asthma
3. To find out the concept of asthma
CHAPTER II
REVIEW OF THEORY
A. Anatomy
a. Nose
Nares anterior are the channels in the nasal cavity. The channels boil into a section
known as the vestibule. The nasal cavity is coated as a mucous membrane which is very rich
in blood vessels, and continues with the farinx layer and with the mucous membrane of the
sinus which has a hole in the nasal cavity. The rice septum separates the two rice cavities.
This thin structure consists of bone and cartilage, often bending to one side or the other,
and coated by both sides with mucous membranes. The lateral wall of the nasal cavity is
formed by some maxilla, palatinus, and os. Sphenoidale. The smooth curvature attached to
the lateral wall and protruding into the nasal cavity is: superior conchae, medium, and
inferior. These bones are lined with mucous membranes.

Pharynx (phlegm)
is a muscular pipe that runs from the base of the skull to its connection with the
osopagus at the height of the cricoid cartilage. Then it is located behind the larinx (larinx-
pharyngeal). The oropharynx is part of the pharynx which is a combination of the respiratory
and digestive systems.
Larynx (throat)
Located on the midline of the front of the neck, inside the skin, the tyroidea gland,
and several small muscles, and in front of the laryngopharynx and the upper part of the
esopagus.
1) Larynx is a complete structure consisting of:
cartilago namely cartilago thyroidea, epiglottis, cartilago cricoidea, and 2 cartilago
arytenoidea
2) Membarana that is connecting cartilago with each other and with the os. Hyoideum,
mucous membrane, vocal plica, and muscles acting on the Cartilago tyroidea vocal plica à
are V-shaped, with V protruding forwards in the neck as Adam's apple. The posterior end of
the upper border is the superior cornu, the protrusion is attached to the thyrohyoideal
ligament, and below is a smaller cornu in which the cricoidea cartilage is outer.
Tyroide membrane à connects the upper border and superior cornu to os hyoideum.
Membrana cricothyroideum à connects the lower border with the cricoidea cartilago.
Epiglottis
Leaf-shaped cartilage and protruding up behind the base of the tongue. This
epiglottis attaches to the back of the V cartilago thyroideum.Plica aryepiglottica, runs
backward from the side of the epiglottis towards the arytenoidea cartilago, forming the
boundary of the laryngeal entrance
Cartilago cricoidea
Cartilago shaped signet ring
with a large part behind. Located below the tyroidea cartilago, it is associated with the
cartilago by the cricotyroidea membrane. The inferior cutaneous cartilago thyroidea
articulates with the tyroidea cartilago on each side. The cricottracheale membrane connects
its lower border with the trachea ring I
Cartilago arytenoidea
Two small pyramid-shaped cartilages located on the base of the cricoidea cartilago. The
vocal fold on each side is attached to the posterior corner of the pyramid that protrudes
forward
Mucous membranes
The larynx is mostly covered by the respiratory epithelium, consisting of ciliated cylindrical
cells. The plica vocalis is covered by a squamous epithelium.
Plica vocalist
The plica vocalis is two thin mucous membrane sheets located above the ligamenturn
vocale, two fibrous bands that are stretched between the inside of the cartilago thyroidea at
the front and the arytenoidea cartilago at the back.
The fake plica vocalis is two folds. membrane mucosa just above the true vocalist plica. This
section is not involved in sound production.
Muscle
Small muscles attached to the arytenoidea cartilago, cricoidea, and thyroidea, which with
contraction and relaxation can bring the vocalist plica closer and separate. These muscles
are innervated by the X cranial nerve (vagus).
Respiration
During quiet respiration, the vocal plica is held slightly apart so that air can get in and out.
During respiration, the vocalis plica is wide apart.
Phonation
Sound is produced by a vocal plica vibration during expiration. The sound produced is
modified by the movement of the soft palate, cheeks, tongue, and lips, and a certain
resonance by the cranial air sinus.
Clinical features
Larynx can be blocked by:
(a) foreign objects, such as clumps of food, small toys
(b) swelling of the mucous membrane, for example after sucking in steam or in an allergic
reaction,
(c) infections, such as diphtheria,
(d) tumors, such as vocal cord cancers.
Trachea or windpipe
Is a flexible tube with a length of about 10 cm with a width of 2.5 cm. the trachea runs from
the cricoidea cartilago down to the front of the neck and behind the manubrium sterni, ends
as high as the sternal angles (manubrium link with the corpus sterni) or up to about the
height of the fifth thoracic vertebrate and in this place splits into two bronchi. The Trachea
is composed of 16 - 20 incomplete circles which contain cartilage rings which are bound
together by fibrous tissue and which complement the circle behind the trachea, while also
making some muscle tissue.
Bronchus
Bronchus, which is formed from the two trachea at an altitude of about the fifth thoracic
vertebrate, has a structure similar to the trachea and is coated by the same cell type. The
bronchus runs downward and sideways towards the lung. The right bronckus is shorter and
wider, and more vertical than the left, slightly higher than the pulmonary artery and
secretes a main branch below the artery, called the lower bronchial lobe. The left bronchus
is longer and slimmer than the right, and runs below the pulmonary artery before splitting
into several branches that run up and down the lobe.
b. Lungs
The lungs are in the thoracic cavity on the left and right. Lungs have:
1. Apex, the lung apex extends into the neck about 2.5 cm above the calvicula
2. the costo surface of the vertebrae, attached to the inside of the chest wall
3. mediastinal surface, attached to the pericardium and heart.
4. and base. Located in the diaphragm
lungs also coated by pleura namely parietal pleura and visceral pleura. Inside the pleural
cavity there is a liquid surfactant which functions for lubrication. The right lung is divided
into three lobes namely the superior, medius and inferior lobes while the left lung is divided
into two lobes, the superior and inferior lobes. Each lobe is wrapped by elastic tissue
containing lymph vessels, arterioles, venules, bronchial venules, alveolar ducts, alveolar sacs
and alveoli. It is estimated that each lung contains 150 million alveoli, so that it has a
sufficiently large surface to place the surface / gas exchange.
Blood supply
1. pulmonary artery
2. bronchial artery
Innervation
1. Parasympathetic through the vagus nerve
2. Sympathetic through truncus simpaticus
Pulmonary Circulation
The lungs have 2 sources of blood supply, from the bronchial arteries and pulmonary
arteries. The blood in the right atrium irrigates the right ventricle through another AV valve,
called the semilunar valve (trikuspidalis). Blood escapes from the right ventricle and flows
through the fourth valve, the pulmonary valve, into the pulmonaic artery. Pulmonaal
arteries branch into the right and left pulmonary arteries, each of which flows right and left.
In the lungs the pulmonary arteries branch out repeatedly into erterioles and then
capillaries. Each capillary perfuses the respiratory tract, through an alveolus, all capillaries
reunite to become venules, and venules become veins. The veins converge to form a large
pulmonary vein.
Blood flows in the pulmonary vein back to the left sodium to complete the blood flow cycle.
Heart, systemic circulation, and pulmonary circulation. Pulmonary blood pressure is around
15 mmHg. The function of pulmonary circulation is that carbon dioxide is released from the
blood and oxygen is absorbed, through a continuous blood cycle around the systemic
circulation and par, the oxygen supply and the release of residual substances can take place
for all
B. PHYSIOLOGY OF ASMA
The human airway is functionally divided into two parts, as a conductor and air exchange.
Even though from the nose to the alveoli the anatomy is different, but its function is a unity.
As the front airway, the nose functions (1) warms, moisturizes and filters air (2) as olfactory
organs and (3) conservation of water vapor and heat to the environment air. This function of
heating, moisturizing and filtering the air is basically to protect the lower airways from the
effects of cold, dry or dirty air due to pollution. If the nose doesn't work for some reason,
the lower airway will be affected. The nasal cavity can be described as a rigid room whose
edges are limited by facial bones and changes in the flow of the breath caused by changes in
the thickness of mucous tissue; this is because the nasal mucous tissue contains many blood
vessels that form sinusoids.
This blood vessel is affected by the nervous system around the nasal cavity so that it is easily
dilated and narrowed. Behind the bronchi and its branches have an incomplete cartilage
ring, which is then complemented by smooth muscle. The more distal the cartilage is, the
smaller, eventually disappears in the bronchioles. Smooth muscle contraction will affect
affect the diameter of the airway. Airway obstruction can occur due to: (1) vaso-dilatation,
(2) tissue edema, (3) mucus plugs, (4) smooth muscle contraction. In rhinitis the role of
vasodilation is very prominent.

C. CONCEPT OF DISEASE
a. Understanding
Asthma is an intermittent, reversible obstructive airway disease wherein the trachea and
the bronchi responds hyperactively to certain stimuli (Smeltzer, 200611)
Asthma is reversible airway obstruction, occurs when the bronchi
b. Etiology
Extrinsic Factor (immunological asthma / allergic asthma)
- Antigen-antibody reaction
- Inhalation of allergens (dust, powders, animal hairs)
Intrinsic factors (non-immunological asthma / non-allergic asthma)
c. Treatment
Pharmacological therapy is one part of treating asthma that aims to reduce the impact of
disease and quality of life, known as asthma management goals. Understanding that asthma
is not only an epidemic of disease but asthma is a chronic disease causing a shift in the focus
of treatment to acute attacks to long-term treatment with the aim of preventing attacks,
controlling or changing the course of the disease.
In principle, asthma treatment is divided into 2 groups, namely anti-inflammatory is a
routine treatment that aims to control the disease and prevent attacks known as controllers
and bronchodilators which is a treatment when an attack to deal with exacerbations or
attacks known as lozenges.
CHAPTER IV
COVER
A. Conclusion
Asthma is a chronic inflammatory airway disorder that involves many cells and their
elements. Chronic inflammation causes airway hypereponse to remember which causes
recurrent episodes of symptoms such as shortness of breath, chest tightness and coughing,
especially at night and / or early in the morning. broad breath, varied and fragile Three
common symptoms of asthma are coughing, dyspnea and wheezing. In some circumstances,
coughing is the only symptom. Asthma attacks often occur at night
Asthma attacks usually start suddenly with a cough and tightness in the chest,
accompanied by slow breathing, wheezing, laborius. Expiration is always more difficult and
longer than inspiration, which drives the patient always harder and longer than inspiration,
which encourages the patient to sit up straight and use each respiratory accessory muscle.
The blocked airway causes dyspnea. Coughing is initially difficult and dry but soon becomes
stronger. Sputum, which consists of a small amount of mucus containing a small, round
coughed gelatinous period. Subsequent signs including cyanosis are secondary to severe
hypoxia and symptoms of carbon dioxide retention including sweating, tachycardia and
pulse pressure.
BIBLIOGRAPHY
Lynda Juall Carpenito, Rencana Asuhan dan Dokumentasi Keperawatan , edisi 2 ,
EGC, Jakarta ,1999.
Perhimpunan Dokter Paru Indonesia .Asma.Jakarta ,2004