PATIENT’S DATA

Name:
Address:
Sex:
Religion:
Birthday:
Age:
Place of birth:
Citizenship:
Civil Status:
Father:
Mother:
Ward:
Attending Physician:

ADMISSION

Date:
Time:
Case No:
Admitting Diagnosis:
Chief Complaint:

HISTORY

Past History:
“Dati na siyang inubo ng malala. Wala namang may malalang sakit sa pamilya namin.” as
verbalized by the mother of the patient.

Present History:
The patient has a difficulty in breathing (dsypnea). He is suffering from bronchial asthma.
DEFINITION OF DISEASE

What's bronchial asthma?

Bronchial asthma is a disease caused by increased responsiveness of the

tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the
bronchial airways. Bronchial asthma is the more correct name for the common form of
asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a
separate condition that is caused by heart failure. Although the two types of asthma have
similar symptoms, including wheezing (a whistling sound in the chest) and shortness of
breath, they have quite different causes.

Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance

of the respiratory passages evokes a feeling of shortness of breath. The cause is a sharply
elevated resistance to airflow in the airways. Despite its most strenuous efforts, the
respiratory musculature is unable to provide sufficient gas exchange. The result is a
characteristic asthma attacks, with spasms of the bronchial musculature, edematous swelling
of the bronchial wall and increased mucus secretion. In the initial stage, the patient can be
totally symptom-free for long periods of time in the intervals between the attacks. As the
disease progresses, increased mucus is secreted between attacks as well, which in part
builds up in the airways and can then lead to secondary bacterial infections. Bronchial
asthma is usually intrinsic (no cause can be demonstrated), but is occasionally caused by
a specific allergy (such as allergy to mold, dander, dust). Although most individuals with
asthma will have some positive allergy tests, the allergy is not necessarily the cause of the
asthma symptoms.

Symptoms can occur spontaneously or can be triggered by respiratory infections,

exercise, cold air, tobacco smoke or other pollutants, stress or anxiety, or by food
allergies or drug allergies. The muscles of the bronchial tree become tight and the lining of
the air passages become swollen, reducing airflow and producing the wheezing sound.
Mucus production is increased.

Typically, the individual usually breathes relatively normally, and will have periodic
attacks of wheezing. Asthma attacks can last minutes to days, and can become dangerous
if the airflow becomes severely restricted. Asthma affects 1 in 20 of the overall
population, but the incidence is 1 in 10 in children. Asthma can develop at any age, but
some children seem to outgrow the illness. Risk factors include self or family history of
eczema, allergies or family history of asthma. Bronchial asthma causes cough, shortness
of breath, and wheezing. Bronchial asthma is an allergic condition, in which the airways
(bronchi) are hyper-reactive and constrict abnormally when exposed to allergens, cold or
exercise.

Treatment is aimed at avoiding known allergens and controlling symptoms through

medication. A variety of medications for treatment of asthma are available. People with
mild asthma (infrequent attacks) may use inhalers on an as-needed basis. Persons with
significant asthma (symptoms occur at least every week) should be treated with anti-
inflammatory medications, preferably inhaled corticosteroids, and then with
bronchodilators such as inhaled Alupent or Vanceril. Acute severe asthma may require
hospitalization, oxygen, and intravenous medications.

Decrease or control exposure to known allergens by staying away from cigarette smoke,
removing animals from bedrooms or entire houses, and avoiding foods that cause
symptoms. Allergy desensitization is rarely successful in reducing symptoms.

Anatomy & Physiology of the Respiratory System

The respiratory system is situated in the thorax, and is responsible for gaseous exchange
between the circulatory system and the outside world. Air is taken in via the upper
airways (the nasal cavity, pharynx and
larynx) through the lower airways (trachea,
primary bronchi and bronchial tree) and into
the small bronchioles and alveoli within the
lung tissue.
Move the pointer over the colored regions of the
diagram; the names will appear at the bottom of the
screen)

The lungs are divided into lobes; the left

lung is composed of the upper lobe, the
lower lobe and the lingula (a small remnant
next to the apex of the heart), the right lung
is composed of the upper, the middle and
the lower lobes.

Mechanics of Breathing

To take a breath in, the external intercostals

muscles contract, moving the ribcage up and
out. The diaphragm moves down at the
same time, creating negative pressure within the thorax. The lungs are held to the thoracic
wall by the pleural membranes, and so expand outwards as well. This creates negative
pressure within the lungs, and so air rushes in through the upper and lower airways.

Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if
they are not held against the thoracic wall. This is the mechanism behind lung collapse if
there is air in the pleural space (pneumothorax).

Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to form very narrow terminal
bronchioles, which terminate in the alveoli. There are many millions of alveoli in each
lung, and these are the areas responsible for
gaseous exchange, presenting a massive surface
area for exchange to occur over.

Each alveolus is very closely associated with a

network of capillaries containing deoxygenated
blood from the pulmonary artery. The capillary
and alveolar walls are very thin, allowing rapid
exchange of gases by passive diffusion along
concentration gradients.
CO2 moves into the alveolus as the concentration
is much lower in the alveolus than in the blood,
and O2 moves out of the alveolus as the continuous
flow of blood through the capillaries prevents
saturation of the blood with O2 and allows
maximal transfer across the membrane.