ASTHMA

 

INTRODUCTION: Asthma is a chronic inflammatory disease of the airways characterized by hyper-responsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. Patients with asthma may experience symptom-free periods alternating with acute exacerbations that last from minutes to hours or days. Asthma, the most common chronic disease of childhood, can begin at any age.

RISK FACTORS: Risk factors for asthma include family history, allergy (strongest factor), and chronic exposure to airway irritants or allergens such as, grass, weed pollens, mold, dust, or animals. Common triggers for asthma symptoms and exacerbations include airway irritants such as, pollutants, cold, heat, strong odors, smoke, perfumes. Others include; exercise, stress or emotional upset, rhinosinusitis with postnasal drip, medications, viral respiratory tract infections, and gastroesophageal reflux.

CLINICAL MANIFESTATIONS: Most common symptoms of asthma are cough (with or without mucus production), dyspnea, and wheezing (first on expiration, then possibly during inspiration as well). Asthma attacks frequently occur at night or in the early morning. An asthma exacerbation is frequently preceded by increasing symptoms over days, but it may begin abruptly. Chest tightness and dyspnea occur. Expiration requires effort and becomes prolonged. As exacerbation progresses, central cyanosis secondary to severe hypoxia may occur. Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse pressure, may occur.

ASSESSMENT AND DIAGNOSTIC METHODS: Family, environment, and occupational history is essential. During acute episodes, sputum and blood test, pulse oximetry, ABGs, hypocapnia and respiratory alkalosis, and pulmonary function (forced expiratory volume [FEV] and forced vital capacity [FVC] decreased) tests are performed.

MEDICAL MANAGEMENT: Pharmacologic Therapy: There are two classes of medications; long-acting control and quick-relief medications, as well as combination products. Short-acting include; beta2-adrenergic agonists, Anticholinergics. Corticosteroids: metered-dose inhaler (MDI). Leukotriene modifiers inhibitors/antileukotrienes. Methylxanthines. The immediate medical care of patients with asthma depends on the severity of symptoms. The patient and family are often frightened and anxious because of the patient’s dyspnea. Therefore, a calm approach is an important aspect of care. Assess the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs. Obtain a history of allergic reactions to medications before administering medications. Identify medications the patient is currently taking. Administer medications as prescribed and monitor the patient’s responses to those medications; medications may include an antibiotic if the patient has an underlying respiratory infection. Administer fluids if the patient is dehydrated. Assist with intubation procedure, if required.  Teach patient and family about asthma (chronic inflammatory), purpose and action of medications, triggers to avoid and how to do so, and proper inhalation technique.

RELATED;

1.  ACUTE RESPIRATORY DISTRESS SYNDROME  

2.  TUBERCULOSIS

3.  ALLERGY

4.  MEDICAL CONDITIONS

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