Bronchial asthma

Fact sheet N206

The scale of the problem Between 100 and 150 million people around the globe -- roughly the equivalent of the population of the Russian Federation -- suffer from asthma and this number is rising. World-wide, deaths from this condition have reached over 180,000 annually.
Around 8% of the Swiss population suffers from asthma as against only 2% some 25-30 years ago. In Germany, there are an estimated 4 million asthmatics. In Western Europe as a whole, asthma has doubled in ten years, according to the UCB Institute of Allergy in Belgium. In the United States, the number of asthmatics has leapt by over 60% since the early 1980s and deaths have doubled to 5,000 a year. There are about 3 million asthmatics in Japan of whom 7% have severe and 30% have moderate asthma. In Australia, one child in six under the age of 16 is affected.

Asthma is not just a public health problem for developed countries. In developing countries, however, the incidence of the disease varies greatly.
India has an estimated 15-20 million asthmatics. In the Western Pacific Region of WHO, the incidence varies from over 50% among children in the Caroline Islands to virtually zero in Papua New Guinea. In Brazil, Costa Rica, Panama, Peru and Uruguay, prevalence of asthma symptoms in children varies from 20% to 30%. In Kenya, it approaches 20%. In India, rough estimates indicate a prevalence of between 10% and 15% in 5-11 year old children.

The human and economic burden Mortality due to asthma is not comparable in size to the day-to-day effects of the disease. Although largely avoidable, asthma tends to occur in epidemics and affects young people. The human and economic burden associated with this condition is severe. The costs of asthma to society could be reduced to a large extent through concerted international and national action.
World-wide, the economic costs associated with asthma are estimated to exceed those of TB and HIV/AIDS combined. In the United States, for example, annual asthma care costs (direct and indirect) exceed US$6 billion. At present Britain spends about US$1.8 billion on health care for asthma and because of days lost through illness. In Australia, annual direct and indirect medical costs associated with asthma reach almost US$460 million.

What is asthma? Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day. This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs. Causes Asthma cannot be cured, but could be controlled. The strongest risk factors for developing asthma are exposure, especially in infancy, to indoor allergens (such as domestic mites in bedding, carpets and stuffed furniture, cats and cockroaches) and a family history of asthma or allergy. A study in the South Atlantic

Island of Tristan da Cunha, where one in three of the 300 inhabitants has asthma, found children with asthmatic parents were much more likely to develop the condition. Exposure to tobacco smoke and exposure to chemical irritants in the workplace are additional risk factors. Other risk factors include certain drugs (aspirin and other non-steroid anti-inflammatory drugs), low birth weight and respiratory infection. The weather (cold air), extreme emotional expression and physical exercise can exacerbate asthma. Urbanization appears to be correlated with an increase in asthma. The nature of the risk is unclear because studies have not taken into account indoor allergens although these have been identified as significant risk factors. Experts are struggling to understand why rates world-wide are, on average, rising by 50% every decade. And they are baffled by isolated incidents involving hundreds of people in a city, who suffer from allergies such as hay fever but who had never had asthma, suddenly being struck down by asthma attacks so severe they needed emergency hospital treatment.
One such incident in London, UK, in June 1994 saw 640 people rushed to emergency departments in the throes of full-blown asthma attacks. A similar incident happened in Melbourne, Australia. Many experts have blamed climatic conditions such as thunderstorms, which break up pollen grains, releasing starch granules that trigger attacks. But they do not know why ordinary hay-fever sufferers developed a life-threatening condition without warning.

Treatment Because asthma is a chronic condition, it usually requires continuous medical care. Patients with moderate to severe asthma have to take long-term medication daily (for example, anti-inflammatory drugs) to control the underlying inflammation and prevent symptoms and attacks. If symptoms occur, short-term medications (inhaled short-acting beta2-agonists) are used to relieve them. Medication is not the only way to control asthma. It is also important to avoid asthma triggers -- stimuli that irritate and inflame the airways. Each person must learn what triggers he or she should avoid. Although asthma does not kill on the scale of chronic obstructive pulmonary diseases (COPD), failure to use appropriate drugs or comply with treatment, coupled with an under-recognition of the severity of the problem, can lead to unnecessary deaths, most of which occur outside hospital. The way forward and the role of the WHO WHO recognizes asthma as a disease of major public health importance and plays a unique role in the coordination of international efforts against the disease. International action is needed to:
increase public awareness of the disease to make sure patients and health professionals recognize the disease and are aware of the severity of associated problems; organize and co-ordinate global epidemiological surveillance to monitor global and regional trends in asthma; develop and implement an optimal strategy for its management and prevention (many studies have shown that this will result in the control of asthma in most patients); and stimulate research into the causes of asthma to develop new control strategies and treatment techniques.

WHO activities International Study of Asthma and Allergies in Childhood (ISAAC): WHO collaborates in ISAAC and, more particularly, in the implementation of the study in developing countries with areas of severe air pollution. A preliminary objective is to obtain information on the association between childhood asthma and air pollution. The first results of this study have shown the prevalence of asthma symptoms to vary from 1.6% to 36.8%. Global Initiative for Asthma (GINA): In 1992, WHO and the US-based National Heart, Lung and Blood Institute jointly formed GINA to cut deaths and disability by developing and implementing an optimal strategy for asthma management and prevention. Since its inception GINA has:
produced a report covering a range of information detailing all the latest knowledge on causes, the mechanism of the disease, risk factors, management, education and socio-economic factors;

developed guidelines on asthma management for doctors, nurses, public health officials, patients and their families; held workshops to introduce the GINA programme to public health officials and medical professionals in more than 80 countries, leading to implementation of the guidelines; been active in disseminating information in 20 languages and bringing together organizations devoted to improving asthma care; backed research efforts to improve asthma management.

GINA's goal is to build an active network with multiple organizations concerned with asthma to ensure better patient care world-wide. WHO Initiative on Allergic Rhinitis and its Impact on Asthma (ARIA):WHO is developing a strategy for the prevention of bronchial asthma through the management of allergic rhinitis. The strategy was conceived by specialists from all over the world at a December 1999 meeting on ARIA. Allergic rhinitis is defined as an allergen-induced inflammation of the membranes lining the nose. Based on the time of exposure to the allergen, allergic rhinitis can be subdivided into perennial, seasonal or occupational disease. Three statements must be taken into account for the successful prevention of bronchial asthma:
Among the broad spectrum of allergic diseases, bronchial asthma is the most prevalent, dangerous and lifethreatening. Underestimated up to now, allergic rhinitis is an important risk factor for asthma. One efficient way to prevent bronchial asthma is to control and treat allergic rhinitis from the very beginning of its inception.

Generally speaking, ARIA will broaden the perspectives for primary prevention of bronchial asthma and will promote better understanding of bronchial asthma among physicians and patients. The specific goals of ARIA are defined as follows:
To increase awareness of allergy and allergic diseases as a preventable public health problem among the medical community, public health officials, and the general public; To prepare evidence-based guidelines for the prevention and management of allergic rhinitis as a key element of primary prevention of bronchial asthma; To educate physicians and other health care professionals about the relevance of allergic rhinitis to bronchial asthma; and To educate the public about the potentially fatal risks of allergy (anaphylaxis) and asthma, especially in children, and to encourage greater dialogue with their physicians. Better education and increased dialogue could avoid approximately 25,000 childhood deaths due to asthma each year

Bronchial Asthma
Ever hear the term "bronchial asthma" and wonder what it means? When people talk about bronchial asthma, they are really talking about asthma, a chronic inflammatory disease of the airways that causes periodic "attacks" of coughing, wheezing, shortness of breath, and chest tightness. According to the CDC, more than 22 million Americans, including 6.5 million children under 18, suffer with asthma today. Allergies are strongly linked to asthma and to other respiratory diseases such as chronic sinusitis, middle ear infections, and nasal polyps. Most interestingly, a recent analysis of people with asthma showed that those who had both allergies and asthma were much more likely to have nighttime awakening due to asthma, miss work because of asthma, and require more powerful medications to control their symptoms. Asthma is associated with mast cells, eosinophils, and T lymphocytes. Mast cells are the allergy-causing cells that release chemicals like histamine. Histamine is the substance that causes nasal stuffiness and dripping in a cold or hay fever, constriction of airways in asthma, and itchy areas in a skin allergy. Eosinophils are a type of white blood cell associated with allergic disease. T lymphocytes are also white blood cells associated with allergy and inflammation. These cells, along with other inflammatory cells, are involved in the development of airway inflammation in asthma that contributes to the airway hyperresponsiveness, airflow limitation, respiratory symptoms, and chronic disease. In certain individuals, the inflammation results in the feelings of chest tightness and breathlessness that's felt often at night (nocturnal asthma) or in the early morning hours. Others only feel symptoms when they exercise (called exercise-induced asthma). Because of the inflammation, the airway hyperresponsiveness occurs as a result of specific triggers.

Signs of a Pending Asthma Attack

Bronchial Asthma Triggers Bronchial asthma triggers may include: Smoking and secondhand smoke Infections such as colds, flu, or pneumonia Allergens such as food, pollen, mold, dust mites, and pet dander Exercise Air pollution and toxins Weather, especially extreme changes in temperature Drugs (such as aspirin, NSAID, and beta-blockers) Food additives (such as MSG) Emotional stress and anxiety Singing, laughing, or crying Perfumes and fragrances Acid reflux Signs and Symptoms of Bronchial Asthma With bronchial asthma, you may have one or more of the following signs and symptoms: Shortness of breath Tightness of chest

Wheezing Excessive coughing or a cough that keeps you awake at night Diagnosing Bronchial Asthma Because asthma symptoms don't always happen during your doctor's appointment, it's important for you to describe your, or your child's, asthma signs and symptoms to your health care provider. You might also notice when the symptoms occur such as during exercise, with a cold, or after smelling smoke. Asthma tests may include:

Spirometry: A lung function test to measure breathing capacity and how well you breathe. You will breathe into a device called a spirometer. Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube to measure the force of air you can expend out of your lungs. Peak flow monitoring can allow you to monitor how well your asthma is doing at home. Chest X-ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing similar symptoms.

Bronchial Asthma
(continued)
Treating Bronchial Asthma Once diagnosed, your health care provider will recommend asthma medication(which can include asthma inhalers and pills) and lifestyle changes to treat andprevent asthma attacks. For example, longacting antiinflammatory asthmainhalers are often necessary to treat the inflammation associated with asthma.These inhalers deliver low doses of steroids to the lungs with minimal side effects ifused properly. The fastacting or "rescue" bronchodilator inhaler works immediatelyon opening airways during an asthma attack. If you have bronchial asthma, make sure your health care provider shows you howto use the inhalers pro perly. Be sure to keep your rescue inhaler with you in case ofan asthma attack or asthma emergency. Wh ile there is no asthma cure yet, thereare excellent asthma medications that can help with preventing asth ma symptoms.Asthma support groups are also available to help you better cope with yourasthma.

Asthma Case Study

August 27, 2008 24 Comments

INTRODUCTION: Asthma is a chronic, reversible, obstructive airway disease, characterized by wheezing. It is caused by a spasm of the bronchial tubes, or the swelling of the bronchial mucosa, after exposure to various stimuli. Asthma is the most common chronic disease in childhood. Most children experience their first symptoms by 5 years of age. ETIOLOGY: Asthma commonly results from hyperresponsiveness of the trachea and bronchi to irritants. Allergy influences both the persistence and the severity of asthma, and atopy or the genetic predisposition for the development of an IgE-mediated response to common airborne allergens is the most predisposing factor for the development of asthma. CLASSIFICATION: 1. Extrinsic Asthma called Atopic/allergic asthma. An allergen or an antigen is a foreign particle which enters the body. Our immune system over-reacts to these often harmless items, forming antibodies which are no rmally used to attack viruses or bacteria. Mast cells release these antibodies as well as other chemicals to defend the body. Common irritants:

Cockroach particles Cat hair and saliva Dog hair and saliva House dust mites Mold or yeast spores Metabisulfite, used as a preservative in many beverages and some foods

Pollen 2. Intrinsic asthma called non-allergic asthma, is not allergy-related, in fact it is caused by anything except an allergy. It may be caused by inhalation of chemicals such as cigarette smoke or cleaning agents, taking aspirin, a chest infection, stress, laughter, exercise, cold air, food preservatives or a myriad of other factors.

Smoke Exercise Gas, wood, coal, and kerosene heating units Natural gas, propane, or kerosene used as cooking fuel Fumes Smog Viral respiratory infections Wood smoke

Weather changes ANATOMY AND PHYSIOLOGY:

The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The lower respiratory tract consist of the bronchi, bronchioles and the lungs. The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood, a process known as gas exchange.

The normal gas exchange depends on three process: Ventilation is movement of gases from the atmosphere into and out of the lungs. This is accomplished through the mechanical acts of inspiration and expiration. Diffusion is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane Perfusion is movement of oxygenated blood from the lungs to the tissues .

Control of gas exchange involves neural and chemical process The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several vital functions such as:

regulating alveolar ventilation by maintaining normal blood gas tension guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia (reduced tissue oxygenation caused by decreased arterial oxygen [PaO2]. An increase in arterial CO2(PaCO2) stimulates ventilation; conversely, a decrease in PaCO2 inhibits ventilation.

helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. however, children respond differently than adults to respiratory disturbances; major areas of difference include: Poor tolerance of nasal congestion, especially in infants who are obligatory nose breathers up to 4 months of age Increased susceptibility to ear infection due to shorter, broader, and more horizontally positioned eustachian tubes.

Increased severity or respiratory symptoms due to smaller airway diameters A total body response to respiratory infection, with such symptoms as fever, vomiting and diarrhea. SIGNS AND SYMPTOMS: 1. Non Productive to Productive Cough 2. 3. 4. 5. 6. 7. Dyspnea Wheezing on expiration Cyanosis Mild apprehension and restlessness Tachycardia and palpitation Diaphoresis

PATHOPHYSIOLOGY: CLINICAL MANIFESTATIONS: 1. 2. 3. 4. 5. 6. 7. 8. Increased respiratory rate Wheezing (intensifies as attack progresses) Cough (productive) Use of accessory muscles Distant breath sounds Fatigue Moist skin Anxiety and apprehension

9. Dyspnea Steps of Clinical and Diagnostic as per National Asthma Education and Prevention Program Mild Intermittent Asthma

Symptoms ? 2 times per week Brief exacerbations

Nighttime symptoms ? 2 times a month Asymptomatic and normal PEF (peak expiratory flow) between exacerbations PEF or FEV, (forced expiratory volume in 1 second) ? 80% of predicted value

PEF variability < 20% Mild Persistent Asthma Symptoms > 2 times/week, but less than once a day Exacerbations may affect activity Nighttimes symptoms > 2 times a month PEF/FEV ? 80% of predicted value

PEF variability 20%-30% Moderate Persistent Asthma Daily Symptoms Daily use of inhaled short-acting ?2 - agonists Exacerbations affect activity Exacerbations ? 2 times a week Exacerbations may last days Nighttime symptoms > once a week

PEF/FEV > 60%-<80% of predicted value PEF variability > 30% Severe Persistent Asthma Continual symptoms Frequent exacerbations Frequent nighttime symptoms Limited physical activity PEF or FEV ? 60% of predicted value

PEF variability > 30 % LABORATORY AND DIAGNOSTIC FINDINGS: Spirometry will detect: a. Decreased for expiratory volume (FEV) b. Decreased peak expiratory flow rate (PEFR) c. Diminished forced vital capacity (FVC) d. Diminished inspiratory capacity (IC) NURSING MANAGEMENT: 1. Assess respiratory status by closely evaluating breathing patterns and monitoring vital signs 2. Administer prescribed medications, such as bronchodilators, anti-inflammatories, and antibiotics 3. Promote adequate oxygenation and a normal breathing pattern 4. Explain the possible use of hyposensitization therapy 5. Help the child cope with poor self-esteem by encouraging him to ventilate feelings and concerns. Listen actively as the child speaks, focus on the childs strengths, and help him to identify the positive and negative aspects of his situation. 6. Discuss the need for periodic PFTs to evaluate and guide therapy and to monitor the course of the illness. 7. Provide child and family teaching. Assist the child and family to name signs and symptoms of an acute attack and appropriate treatment measures 8. Refer the family to appropriate community agencies for assistance.

Nursing Care Plan Brochial Asthma

June 14, 2008 26 Comments

Bronchial asthma is a chronic inflammatory disease of the airways, associated with recurrent, reversible airway obstruction with intermittent episodes of wheezing and dyspnea. Bronchial hypersensitivity is caused by various stimuli, which innervate the vagus nerve and beta adrenergic receptor cells of the airways, leading to bronchial smooth muscle constriction, hypersecretion of mucus, and mucosal edema. The symptoms of bronchial asthma includes:

a feeling of tightness in the chest; difficulty in breathing or shortness of breath; wheezing; and coughing (particularly at night).

Asthma triggers may include:

Tobacco smoke Infections such as colds, flu, or pneumonia Allergens such as food, pollen, mold, dust mites, and pet dander Exercise Air pollution and toxins Weather, especially extreme changes in temperature Drugs (such as aspirin, NSAID, and beta-blockers) Food additives (such as MSG) Emotional stress and anxiety Singing, laughing, or crying Smoking, perfumes, or sprays Acid reflux

NursingCrib.com Nursing Care Plan Bronchial Asthma