Bronchial Asthma

 Bronchial Asthma

Bronchial asthma is chronic inflammatory disease withj lumen of bronchi and branchioles.

Spasm of smooth muscles of bronchi.

Edema of bronchial mucosa

Increase secretion and accumulation of tenacious mucus.

Airway get narrow and swollen; blocked by excess mucus.

Bouts of dyspnea (short period of intense activity)

Temporary narrowing of bronchi due to branchospasm, mucosal edema, thick secretion.

Etiology

Obstructive processes.

Increase responsiveness of trachea and bronchi to stimuli triggered.

Extrinsic asthma or allergic asthma such as pollen, home dust, smoke, powder.

Intrinsic asthma (non allergic Asthma)

Airway abstruction

Non IgE mediated

Triggered by exercise, drug like aspirin, changes in temperature, viral respiratory infection, emotional stress, excitement.

Risk factors

1. Endogenous factors

Sex/gender

Family history

Atopy/Allergy

2. Extrogenous factors

Viral infection

Exposure to allergens

Passive tobacco smokingb(secong hand smoking)

Low socioeconomic status

Lack of breastfeeding

Pathophysiology

Exposure to allergen or triggers; dust, pollen, smoking

Inflammatory response (increase IgE)

Activate mast cella, t cells, eosinophils

Leukotriene 

Bronchoconstriction

Airway edema and increase mucus production

Airway obstruction

Hypoxia, wheezing, dyspneaby mast cell damage wall of airways, causing epithelium shedding and mucus production.

Hyperventilation (increase PH, decrease PaCO2)

Hypoventilation

Apnea and death

Clinical manifestations

Sudden onset and after occur at night

Asthmatic area; feeling of tightness in chest, restlessness, polyuria or coughing spell; causing spasm.

Severe dysnea

Bouts of cough

Wheezing (mainly expiratory)

Cyanosis

Pallor

Sweating

Restlessness

Excessive use of accessory muscle of respiration

Extreme fatigue

In chronic cases; chest of child become barrel shaped.

Severe attack of asthma result in;

Hypoxia, cyanosis, cardiac arrhythmias

Diagnostic Evaluation

1. History taking and physical examination

2. Pulmonary function test (spirometery)

3. Blood examination

Increase eosinophils

4. Chest X rays 

Air trapping in lungs

Area of atelectasis due to mucus. (Comple or partial collapse of lobe of lung. Tiny sac at end don't expand (inflate) properly.

5. Allergy test

Skin test and RAST (radio-allergo- sorbent allergen specific IgE)

(Identify causative agent)

Types 

1. Allergic asthma

2. Seasonal asthma

3. Occupational asthma

4. Non allergic asthma

5. Excercise induced asthma

6. Childhood asthma

7. Brittle Asthma (unstable); severe form of asthma

Management

During acute attack

Controlling bronchospasm

Relieve inflammation

Medication

1. Fast acting drugs

Short-acting beta adrenoceptor agonists (SABA); inhaler 

Salbutamol first line treatment for bronchial asthma.

2. Anticholinergic medication

Ipratropium bromide

3. Inhaled epinephrine

Not recommended due to excessive cardiac stimulation.

2. Long term control

Asthma spacer or dry powder inhaler; matered dose inhaler (MDI).

Fluticasone propionate; inhaler

Glucocorticoids; inhale form

Long acting beta - adrenoceptor agonists (ABA)

3. Oxygen Administration; alleviate hypoxia

4. Magnesium sulfate; IV treatment

5. Heliox; mixture of helium and oxygen

6. Methylxanthines (theophylline)

Nursing Management

1. Evaluate Respiratory status and facilitate breathing

2. Educate; when asthma attack, sitting up straight allow air more effectively enter lungs.

3. Administer adequate fluid

Decrease fluid intake; Increase Respiratory effort/ hyperventilation