Lesson Plan on Asthma By: Rabiu Hassan Musa

DefinitionAsthma is defined as a chronic inflammatory disease of the airways associated with airway hype responsiveness causing wide spread but variable airflow obstruction within the lungs that is often reversible either spontaneously or with treatment.Global Initiative for Asthma Management (GINA 2010)

Asthma can be defined as a chronic reactive airway disorder that involves episodic, reversible airway obstruction resulting from bronchospasm, increased mucous secretion and mucosal edema. It is characterized by airway inflammation, intermittent airflow obstruction and bronchial hyper responsivenessAsthma is a chronic inflammatory disorder characterized by episodic exacerbations of acute inflammations of the airway.

Epidemiology In 2005, an estimated 7.7% of the peoples (22.2 Millions) currently had asthma.

Rate decreased with age 8.9% of children (6.5%) had asthma compared to 7.2% of adults (15.7 Million)

Classification Intermittent asthma Mild persistent asthma Moderate persistent asthma Severe persistent asthma

1. Intermittent Asthma Its an asthma with symptoms of 2 daysper week or less, and night time awakening twice a month or less There is no interference with normal activity Short acting beta agonists usage for symptoms control of 2 days a week or lessPulmonary function test shows normal FEV1 between exacerbations

2. Mild persistent Asthma It has a symptoms of more than twice a week, but not daily. Night time awakenings of 3 to 4 times permonth There is minor limitations of normal activity Short acting beta agonists usage controlsymptoms of more than 2 days a week but notMore than once daily Pulmonary function test shows FEV1 greaterthan 80% predicted. FEV/FVC are normal

3. Moderate persistent it is an asthma with symptoms every day Night awakening of more than once a week but not every night There is some activity limitations Short acting beta agonists usage forsymptom control is on daily basis Pulmonary function test shows FEV1greater than 60% but less than 80%predicted. FEV1/FVC reduced 5%

4. Severe persistent Symptoms is throughout the day Night time symptoms is 7 times per week Activity is extremely limited Short acting beta agonists usage forsymptom control is several times a day Pulmonary function test shows FEV1 less than 60% predicted. FEV1/FVC reduced more than 5%

Incidence It accounts for nearly a half million hospitalizations each yearIt is more prevalent in African Americans than in whitesDeath from asthma is more common in lower socio-economic groups

Types of asthmaAllergic asthma (extrinsic)Non allergic asthma (intrinsic)Mixed asthma

1. Allergic asthma (extrinsic) This occurs in response to allergens, such as pollen, dust, spores and animal dander

2. Non allergic asthma (intrinsic)This is associated with factors such as upper respiratory tract infections, emotional upsets, and exercise.

3. Mixed asthma This is an asthma which shows the characteristics of both allergic and non allergic asthma

Etiological factors 1. Asthma triggers2. Cormobidities

1. Asthma triggers Genetic tendency Viral respiratory infections Tobacco smoke Air pollution Early use of antibiotics Sensitization to house dust, mites and cockroaches

Atopy Exposure to allergens and irritants Frequent RTIs Exercise, cold air, strong odors, perfume, rhinosinusitis, and stress GERD Ingestion of sulfites

2. Cormobidities Drug induced asthma Allergic reactions such as eczema, rashes and temporary edema NSAIDs

Pathophysiology

Clinical features Itching on the neck Cough Wheezing Bronchospasm Sudden breathlessness Mucosal edema Mucus production Thick secretions Increased respiratory rate with use of accessory muscles

Prolonged expiration phase Increased pulse rate Increased blood pressure Chest tightness Diaphoresis Nasal flaring Lung hyper inflation Hype resonance to percussion Barrel chest

Decreased breath sounds Lethargy Cyanosis Silent chest Adventitious breath sound in lung bases Respiratory alkalosis Decreased ability to speak Status asthmaticus

Diagnostic evaluations History collection and Physical examinationSputum and blood testsSerum IgE levelABG and Pulse oxymetryPulmonary Function TestChest X-raysSkin allergen testingBronchial challenge testingPeak flow monitoring

Management Adrenergic broncho dilators e.g. albuterol, metaproterenol Anti cholinergic e.g. ipratropium, tiotropiumMethylxanthines e.g. thiophillin, aminophillin Corticosteroids e.g. methylprednisolone, beclomethasone Mastcell stabilizers e.g. cromolyn sodium, nedocromilMedical Management

Expectorants e.g. robitussin, mucinexAntileukotrienes e.g. zafirlukast, montelukastAntitussives e.g. codeine, dextromethorpanShort acting beta agonists e.g. albuterol (ventolin)Long acting beta agonists e.g. formoterol, salmeterol Monoclonal antibodies e.g. omalizumabAnti inflammatory e.g. nedocromil sodium,

Nursing management Calm approach to reduce the client anxietyRespiratory status assessmentObtain history of allergic reactions to medications before administering any drugOxygen administrationEnsure adequate rest and fluid intakeGive prescribed inhalersEncourage purse lip and diaphragmatic breathing

Assist in intubation and mechanical ventilation if need bePerform postural drainage SuctioningMaintain temperature

Therapeutic measure and patients educationSelf monitoringAvoidance of triggersMedications

ComplicationsStatus asthmaticusOthers Airway obstructionAsphyxiaExhaustion AtelectesisPneumothoraxMediastinal and subcuteneous emphysemaCorpulmonale and pneumonia