BRONCHIAL ASTHMA

Islamic University Islamic University

Nursing College Nursing College

DefinitionAsthma is a chronic inflammatory disease of

the airways which develops under the allergens

influence, associates with bronchial

hyperresponsiveness and reversible obstruction and

manifests with attacks of dyspnea, breathlessness,

cough, wheezing, chest tightness and sibilant rales

more expressed at breathing-out.

EpidemiologyAccording to epidemiological studies asthma

affects 1-18% of population of different countries.

Only in 2006 more than 300 million patients

suffered from asthma all over the world, 250

thousands of patients die of asthma. The incidence of

asthma is higher in countries with increased air

pollution.

causes

Allergic reactions to plants, foreign

bodies in the air way.

Etiology

The allergens

are divided into:

•Communal,

•Industrial,

•Occupational,

•Natural

•Pharmacological

Сommunal allergens are contained in the air of

apartment houses. They are:

House-dust mites which live in carpets سجادة,

mattresses and upholstered المنجد ;furnitureاالثاث

Vital products of domestic insects (e.g.,

cockroachالصرصور);

Tobacco smoke during active or passive smoking;

Various communal aerosols and synthetic

detergents.

Among the industrial allergens nitric, carbonic,

sulfuric oxides, formaldehyde, ozone and emissions of

biotechnological industry - main components of industrial

and photochemical.

The most important occupational allergens are

dust of stock buildings, mills مطاحن , weaving-mills, book

depositories etc.

Natural allergens are represented by plant pollen

(especially ambrosia عطور, wormwood and goose-foot pollen)

and different respiratory, particularly viral, infections.

Some allergens which may cause asthma

House-dust mites which live in carpets, mattresses and upholstered furniture

Spittle, excrements, hair and fur of domestic animals

Plant pollen

Pharmacological agents (enzymes, antibiotics, vaccines, serums)

Food components (stabilizers, genetically

modified products)

Dust of book depo-sitories

Asthma Triggers

©2010

Trigger-factors, which provoke

bronchospasm, are: a simultaneous penetration

of a large quantity of allergen, viral respiratory

infection, hyperventilation, physical exertion,

emotional stress, becoming too cold, adverse

weather conditions, administration of some

medicines (aspirin, -blockers).

Pathophysiology

Asthma pathophysiology is quite

difficult and insufficiently studied. Undoubtedly,

in most cases the disease is based on 1 type

hypersensitivity reaction. The genesis of

any allergic reaction may be divided into

immune, pathochemical and pathophysio-

logic phases.

Classifications of Asthma

1. Spasmodic: sporadic in nature with varying

intervals of free and difficulty due to

precipitating factors often readily defined.

2. Continuous: some shortness of breath on

occasion, transit wheezing on strenuous

exercise and wheezy rales hard deep

inspiration.

Classifications of Asthma cont…

3. Intractable: persistent wheezing

requiring regular daily medication for either

control of symptoms or ability to function.

4. Status Asthmaticus: sever attach in

which patient deteriorates in spite of

adequate treatment.

Clinical manifestationsClassic signs and symptoms of asthma are:

Attacks of expiratory dyspnea

Shortness of breath

Cough.

Chest tightness

Wheezing (high-pitched whistling sounds when

breathing out)

Sibilant rales

In typical cases in development of asthma exacerbation there are 3 periods – prodromal period, the height period and the period of reverse changes.

At the prodromal period:

vasomotoric nasal reaction with profuse watery discharge,sneezing, dryness in nasopharynx, paroxysmal cough with viscous sputum, emotional lability, excessive sweating, skin itch and other symptoms may occur.

At the peack of exacerbation there are:

expiratory dyspnea

forced position with supporting on arms

poorly productive cough

cyanotic skin and mucous tunics

hyperexpansion of thorax with use of all accessory muscles

during breathing

at lung percussion: tympanitis, shifted downward lung

borders

at auscultation: diminished breath sounds, sibilant rales,

prolonged breathing-out, tachycardia.

in severe exacerbations: the signs of right-sided heart

failure (swollen neck veins, hepatomegalia), overload of

right heart chambers on ECG.

At the period of the reverse changes,

Which comes spontaneously or under

pharmacologic therapy.

Dyspnea and breathlessness relieve or

disappear.

Sputum becomes not so viscous.

Cough turns to be productive.

Patient breathes easier.

Asthmatic statusThe severe and prolonged asthma exacerbation with

intensive progressive respiratory failure, hypoxemia,

hypercapnia, respiratory acidosis, increased blood viscosity and

the most important sign is blockade of bronchial 2-receptors.

Stages:

1st - refractory response to 2-agonists (relaxation of the smooth

muscles)

2nd - “silent” lung because of severe bronchial obstruction and

collapse of small and intermediate bronchi;

3rd stage – the hypercapnic coma.

In many cases asthma, particularly intermittent,

manifests with few and atypical signs:

episodic appearance of wheezing;

cough, heavy breathing occurring at night;

cough, hoarseness after physical activity;

“seasonal” cough, wheezing, chest tightness

the same symptoms occurring during contact with

allergens, irritants;

lingering course of acute respiratory infections.

DiagnosisTypical clinical manifestations and lung function assessment are sufficient for diagnosis of asthma.

Management1. Avoiding the contact with allergen. If it is impossible, the

specific hyposensitization with standard allergens should

be performed. It is rather effective in case of monoallergy,

in intermittent and mild persistent asthma, in remission

phase.

2. Elimination of trigger factors (rational job placement,

changing the residence, psychological and physical

adaptation, careful drug using) is the second condition for

successful asthma treatment.

3. Optimally selected medical care is the base of asthma

management.

Combined inhaled drugs (corticosteroids with 2-agonists) (nebulasers, turbuhalers, spasers, spinhalers, sinchroners) enhance the effectiveness of asthma therapy.

Management of asthmatic status

Oxygen

Systemic corticosteroids (Hydrocortisone 200mg or

Prednisolone 50 mg/day per)

Inhalations of short-acting 2-agonists - Salbutamol 5mg or

Fenoterol 2mg through nebulaser – 3 times at 1st hour, then

once an hour till distinct improvement of patient’s condition is

achieved; then 3-4 times a day.

Inhaled anticholinergic drugs or Aminophylline IV.

If ineffective - artificial lung ventilation.

Prognosis

In case of early detection and adequate

treatment the prognosis for the disease is

favourable.

It becomes serious in severe persistent

and poorly controlled (insensitive for

corticosteroids) asthma.

The examination of working capacity

The patients with unfavorable for the

disease conditions of work need the job

replacement.

Physical labours with severe asthma are

disable to work.

Prophylaxis

Preservation of the environment,

healthy life-style (smoking cessation,

physical training) – are the basis of primary

asthma prophylaxis. These measures in

combination with adequate drug therapy

are effective for secondary prophylaxis.