Asthma

Introduction
Asthma is a non-communicable chronic lung
disease, characterized by the following features:
Airway inflammation
Airway obstruction mainly due to associated with
mucosal edema

INCIDENCE
The incidence of asthma has steadily increased in both
developed and developing countries from 1970 to 2000.The
prevalence of asthma has increased 61% over the last two
decades.
Asthma is the leading chronic illness among children.
Asthma results in 10 million lost school days and 3 million
lost work days.
Deaths from asthma have increased by 31% since 1980.
By 1 year – 26%
 1-5 years – 51.4%
 > 5 years – 22.3%
77% Of Asthma Begins In Children Less Than 5 Years.

ETIOLOG
Y1. Host factors:
1. Genetic; Genes
2.Sex: More in males 2:1
2.Environmental factors:
1. Allergens –
2.Infections: (predominantly viral in 40% of children)
3.Seasonal: Seasonal variation of asthma attacks is experienced
by 35% of children.
4.Diet: ( eggs, wheat).

3. Sensitization to allergen.
4. Pollutants (particularly environmental tobacco
smoke, mosquito coil smoke, sprays, perfumes etc).
5. Respiratory (viral) infections.
6. Psychosocial factors.
7. Drugs (aspirin, beta blockers)

Due to etiology
Inflammation & edema of the mucous
membranes.
Accumulation of secretions from mucous
glands.
Spasm of the smooth muscle of the bronchi &
bronchioles

CLINICAL
MANIFESTATIONS:The classical manifestations are: dyspnea,
wheezing, & cough.
Nocturnal Cough/Breathlessness.
Asthmatic child may complain headache, feeling
tired,
& chest tightness.

 Respiratory symptoms:
Recurrent cough:
Post-tussive vomiting (vomiting after a bout of coughing)
occurs in 5% of cases
Chest pain is present rarely.
Other comorbid conditions like allergic rhinitis, sinusitis,
serous otitis media, etc.
Shortness of breath.

DIAGNOSIS
1. HistorY collection(Ask)
Has the child had an attack or recurrent episode of
wheezing (high-pitched whistling sounds when breathing
out)?
Does the child have a troublesome cough which is
particularly worse at night or on waking?
Is the child awakened by coughing or difficult breathing?
Does the child cough or wheeze after physical activity
(like
games and exercise) or excessive crying?
Does the child experience breathing problems during a
particular season?

2. Physical Examination (Look).
Dyspnea
Irritability to Cough
Allergic Rhinitis
3. Chest x ray: Chest X-ray is not needed to
diagnose asthma. It is needed only when the
diagnosis is not clear or any complications are
suspected.

MEDICAL MANAGEMENT
1. Oxygen : Give oxygen to keep oxygen saturation > 95% in all
children with asthma who are cyanosed (oxygen saturation ≤
90%) or whose difficulty in breathing interferes with talking,
eating or breastfeeding.
• Pharmacotherapy:
Quick relievers: Used for acute attacks to relieve bronchospasm
as and when needed.
 Salbutamol
 Terbutaline
 Adrenaline
 Aminophylline
Preventers: Used for long-term to control the inflammation and
to prevent further attacks.
 - Steroids ( Oral and Inhaled) like prednisolone.
 - Theophylline

Long-term symptom relievers: Used to
relievebronchospasm for longer hours.
– Salmeterol
– Formoterol
– Bambuterol
Always use with inhaled
Steroids

If the methods of delivering salbutamol are not
available, give a subcutaneous injection of adrenaline
at 0.01 ml/kg of 1:1000 solution (up to a maximum of
0.3 ml), measured accurately with a 1-ml syringe. If
there is no improvement after 15 min, repeat the dose
once.
Magnesium sulfate : Intravenous magnesium sulfate
may provide additional benefit in children with severe
asthma treated with bronchodilators and
corticosteroids. Give 50% magnesium sulfate as a
bolus of 0.1 ml/kg (50 mg/kg) IV over 20 min.

NURSING
MANAGEMENT
The management of asthma
includes:
Education
Environment control
Evaluation
Emotional support
Regular follow-up.

1. Education: The nurse must spend time to clear the misconceptions
about the disease, sexual bias, non-communicability of the disease, fear
of inhalers, steroids, etc.
2. Environment Control
It is the most important factor in the control of asthma. The aim should be
to avoid allergens and irritants:

3. Evaluating respiratory status and patients
general condition
Frequent assessment of respiratory pattern.
Cyanosis
Breath sounds
Vital signs

4. Providing emotional support:-
Calm and quiet approach
Trusting relationship
Play and recreation
5. Positioning:-
Comfortable sitting position and supporting
with
pillow.
Leaning forward with support may be allowed
Administering oxygen

6. Administering fluid therapy:-
During asthma they take less fluid.
Maintain input output chart
7. Maintaining adequate dietary intake:-
Clear liquids in small amounts.
Allergic foods to be avoided.
Spicy and gas forming foods to be avoided.
Balanced diet.

8. Maintenance of hygienic
measures:-
Routine hygiene care.
Dust and allergen free environment.
Aseptic technique.
9. Supporting parents and family
Emotional support
Parent participation in care
Discuss treatment plan.


Asthma

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