BRONCHIAL ASTHMA =

is a chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production. Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens also increases the risk for developing asthma. Asthma can occur at any age and is the most chronic disease of childhood. 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 normally 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: Smoke Exercise Stress Laughter Gas, wood, coal, and kerosene heating units Natural gas, propane, or kerosene used as cooking fuel Viral respiratory infections Wood smoke Weather changes

SIGNS & SYMPTOMS: 1. Non- productive to productive cough 2. Dyspnea 3. Wheezing on expiration 4. Cyanosis 5. Chest tightness 6. Diaphoresis 7. Tachycardia and palpitation

ANATOMY AND PHYSIOLOGY: The respiratory system consists of all the organs involved in breathing. 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. How they work When you breathe in, air enters your body through your nose or mouth. From there, it travels down your throat through the larynx (or voicebox) and into the trachea (or windpipe) before entering your lungs. Air enters your lungs through a system of pipes called the bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are where the important work of gas exchange takes place between the air and your blood. Covering each alveolus is a whole network of little blood vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that the air in the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will travel across the walls of the alveoli into your bloodstream. Traveling in the opposite direction is carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is then breathed out. In this way, you bring in to your body the oxygen that you need to live, and get rid of the waste product carbon dioxide. The Lungs The lungs are paired, cone-shaped organs, along with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right lung. These are divided up into lobes. The right lung has three lobes but the left lung has only two, because the heart takes up some of the space in the left side of our chest. The lungs can also be divided up into even smaller portions, called bronchopulmonary segments. PATHOPHYSIOLOGY: Asthma is a disorder due to obstruction to breathing due to inflammation and narrowing of the bronchial tube, initially the bronchial tube become inflamed and produced thick mucus, later the muscles surrounding this airways tightens and the air cannot move freely this is called bronchospasm. The result is shortness of breath and the air moving through the tightened airway causes a whistling sound known as wheezing.

COMPLICATIONS:
1. Status Asthmaticus 2. Respiratory Failure 3. Pneumonia 4. Atelectasis

MEDICAL MANAGEMENT:
Long-Acting Control Medication Corticosteroid Beclomethasone (Beclovent, Vanceril), Budesonide (Pulmicort), Flunisolide (AeroBid), Fluticasone propiionate (Flovent), prednisone Cromolyn sodium (Intal), nedocromil sodium (Tilade) Salmeterol (Serevent), albuterol (Volmax ER), Aminophylline, Theophylline Montelukast (Singulair) Albuterol sulfate + ipratropium bromide (combivent), Fluticasone propionate + salmeterol inhalation powder (Advair Diskus)

Mast Cells Stabilizers Long-Acting beta2-adrenergic agents Xantines derivatives Leukotriene modifiers Combination products

Quick-Relief Medication Short-acting beta2-adrenergic agents Albuterol ( Proventil), Levabuterol ( Xopenex),Pributerol ( Maxair), Bitolterol ( Tornalate) Ipratropium Bromide ( Atrovert)

Anticholinergics

NURSING MANAGEMENT
A. Dependent Nursing Intervention: 1. Administer prescribed medications such as bronchodilators, anti-inflammatories and antibiotics etc. And monitor the patients's response to those medication. 2. Fluids may be administer if the patients is dehydrated. B. Independent Nursing Intervention: 1. Asses the patient respiratory status by monitoring the severity of symptoms, pulse oximetry, and vital signs. 2. Provide calm environment. 3. Promote adequate oxygenation and a normal breathing pattern 3. Place in semi to high fowlers position. 4. Instruct to increase oral fluid intake. 5. Provide comfort measures.

6. Bronchial tapping after each nebulization. 7. Avoid exposure to allergens. 8. Help the patient cope with poor self-esteem by encouraging him to ventilate feelings and concerns. Listen actively as the patient speaks, focus on the patient's strengths, and help him to identify the positive and negative aspects of his situation. 9. Provide patient and family teaching. Assist the patient and family to name signs and symptoms of an acute attack. 10. Refer the family to appropriate community agencies for assistance.