Asthma

Chronic inflammatory disorder of the airways causing bronchoconstriction, inflammation, and increase mucus production due to hyperresponsiveness to stimuli or triggers.

Signs and symptoms

• Wheezing or crackles

• Absent or diminished lung sounds “silent chest”

• Chest tightness

• Use of accessory muscles for breathing

• Cough

• Prolonged exhalation

• Cyanosis

• Diaphoresis

• Decreased oxygen saturation

• Hyperresonance

• Inability to complete a sentence

• Restlessness

• Tachycardia and tachypnea with hyperventilation

• Pulsus paradoxus
  

Interventions

• Position the patient in high Fowler’s or sitting position or slightly bent forward (Tripod)

• Administer oxygen as prescribed

• Administer bronchodilator (e.g., salbutamol [Ventolin]) as prescribed (given first to open the airway, so that the corticosteroid can penetrate deeper and be more effective)

• Administer corticosteroid (e.g., fluticasone (Flovent) as prescribed

• Stay and reassure the patient to reduce anxiety

• Auscultate lung sounds before, during, and after treatment

• Record the color, amount, and consistency of the sputum

• Monitor pulse oximetry and vital signs
  

Main causes

Causes of airway hyperresponsiveness and inflammation is unknown

Triggers:

1.     Allergens – animal dander, pollens, house dust mites, molds, cockroaches

2.     Air pollutants – perfumes, cigarette smoke, fumes, aerosol spray

3.     Viral upper respiratory infection – cold and flu

4.     Stress

5.     GERD

6.     Cold dry air

7.     Drugs – aspirin, NSAIDS, beta blockers

8.     Sinusitis

Potential complications

• Status asthmaticus – severe life-threatening attack that is refractory to usual treatment and places the patient at risk of respiratory failure

• Respiratory failure

• Atelectasis

• Pneumonia
  

Laboratory assessments/Diagnostic test

• History and physical examination

• Pulmonary Function Test (PFT) including response to bronchodilator therapy (FEV1)

• Peak Expiratory Flow Rate (PEFR) monitoring

• ABG and pulse oximetry

• Allergy skin testing
  

Education

• Instruct the patient on reducing exposure to asthma triggers.

• Teach the patient regarding self-management programs that includes self-monitoring, either by symptoms or peak flow

• Help the patient develop an asthma action plan as directed by the physician

• Teach the patient what to do if an asthma episode occurs

• Teach the patient regarding exercises or activities suited for individual with asthma e.g., Doing activities with rest periods, avoiding strenuous exercises, taking bronchodilator as prophylaxis before activity, avoiding extreme weathers (windy, cold, humid, very hot), stopping activity and taking bronchodilator if signs and symptoms occur, choosing sports with rest periods (e.g., baseball or swimming.