Asthma

What is asthma?
Asthma is a disease in which the airways become blocked
or narrowed. These effects are usually temporary, but they
cause shortness of breath, breathing trouble and other
symptoms. If an asthma attack is severe, a person may
need emergency treatment to restore normal breathing.

People with asthma can be of any race, age or sex.

Despite the far-reaching effects of asthma, much remains
to be learned about what causes it and how to prevent it.
Although asthma can cause severe health problems, in
most cases treatment can control it and allow a person to
live a normal and active life
Pediatric Asthma
Children's airways are narrower than those of adults.
This means that triggers may cause much more serious
responses in children. For this reason, it is important
that asthma be diagnosed and treated correctly. For
some children, this may mean taking daily medication
even during times when the child is not having
symptoms of asthma.
 What causes asthma attacks?
Things in the environment trigger an asthma attack. These triggers
vary from person to person, but common ones include cold air,
exercise, allergens (things that cause allergies) such as dust mites,
mold, pollen, animal dander or cockroach debris, and some types of
viral infections.

Asthma is caused by environmental and genetic factors, which can

influence how severe asthma is and how well it responds to
medication. Some environmental and genetic factors have been
confirmed by further research, while others have not been.
Underlying both environmental and genetic factors is the role of the
upper airway in recognizing the perceived dangers and protecting the
more vulnerable lungs by shutting down the airway.
Here is how the process occurs. When the airways come
into contact with an allergen, the tissue inside the
bronchi and bronchioles becomes inflamed
(inflammation). At the same time, the muscles on the
outside of the airways tighten up (constriction), causing
them to narrow. A thick fluid (mucus) enters the
airways, which become swollen. The breathing passages
are narrowed still more, and breathing is hampered.
 Incidence
WHEN asthma was first identified about a century ago, it was a relatively rare
disease. Then, in the 1970s, for reasons medical science doesn't fully
understand, asthma started to become far more common - and far more deadly.
In the Philippines, asthma affects some 8 million children. Of the 56 countries
which participated in the phase 1 of International Study on Asthma and
Allergies in Children, the Philippines ranked 32nd in "self-reported asthma." The
country has a prevalence rate of about 12 percent.
A nationwide study conducted by the University of Santo Tomas showed that
about 12.4 percent of children aged 14-15 years old are afflicted with asthma.
Over all, one out of 10 Filipinos has asthma, based on a Philippine General
Hospital survey.

"This is alarming, for it means school-children may have their performance in

school affected and young adults may lose out on job opportunities and
decrease their earning potential due to their ailment. If not treated early,
children who are affected with the disease will become disabled," said asthma
specialist Dr. Dina Diaz of the Lung Center of the Philippines.
 Why are some infants and toddlers more
susceptible to getting asthma?
The process just described can be normal, up to a
point. Everyone's airways constrict somewhat in
response to irritating substances like dust and mold.
But in a person with asthma, the airways are hyper-
reactive. This means that their airways overreact to
things that would just be minor irritants in people
without asthma.

To describe the effects of asthma, some doctors use

the term "twitchy airways." This is a good description
of how the airways of people with asthma are
different from those without the disease. Not all
patients with hyper reactive airways have symptoms
of asthma, though.
We still do not know what causes some people to develop
asthma. Research shows that a family history of asthma or
allergies, a specific allergy in the child or cigarette smoking
during pregnancy may increase the likelihood that a person
will develop asthma early in life.
One of the most common causes of asthma symptoms in
children five years old and younger is a respiratory virus.
Although both adults and children experience respiratory
infections, children have more of them and some preschool
children are plagued with viral infections. At least half of
children with asthma show some sign of it before the age of
five. Viruses are the most common cause of acute asthma
episodes in infants six months old or younger.
Infants and toddlers have much smaller
bronchial tubes than older children and
adults. In fact, these airways are so small
that even small blockages caused by viral
infections, tightened airways or mucous can
make breathing extremely difficult for the
child.
 Asthma Symptoms
People with asthma experience symptoms when the airways
tighten, inflame, or fill with mucus. Common asthma
symptoms include:
Coughing, especially at night
Wheezing
Shortness of breath
Chest tightness, pain, or pressure
Still, not every person with asthma has the same symptoms in
the same way. You may not have all of these symptoms, or
you may have different symptoms of asthma at different
times. Your symptoms may also vary from one asthma attack
to the next, being mild during one and severe during another.
Signs of asthma in a baby or toddler
include:
Noisy breathing or breathing increased 50 percent
above normal
Normal respiration rates:
newborns 30-60 breaths/minute
1st year 20-40 breaths/minute
2nd year 20-30 breaths/minute
Wheezing or panting with normal activities
Lethargy, disinterest in normal or favorite
activities
Difficulty sucking or eating
Crying sounds softer, different
Early warning signs are changes that happen just
before or at the very beginning of an asthma
attack. These signs may start before the well-
known symptoms of asthma and are the earliest
signs that your asthma is worsening.
In general, these signs are not severe enough to
stop you from going about your daily activities.
But by recognizing these signs, you can stop an
asthma attack or prevent one from getting worse.
Early warning signs include:
* Frequent cough, especially at night
* Losing your breath easily or shortness of breath
* Feeling very tired or weak when exercising
* Wheezing or coughing after exercise
* Feeling tired, easily upset, grouchy, or moody
* Decreases or changes in lung function as measured on
a peak flow meter
* Signs of a cold or allergies (sneezing, runny nose,
cough, nasal congestion, sore throat, and headache)
* Trouble sleeping
How is asthma diagnosed in babies and
toddlers?
Diagnosing asthma in very young children is difficult.
Since they are not able to communicate, they cannot
describe how they are feeling. A baby's fussy behavior
could mean many things; however, toddlers and
preschoolers often continue to be fairly active in spite
of increasing chest tightness or difficulty with
breathing.

To help the pediatrician make a correct diagnosis,

parents must provide information about family
history of asthma or allergies, the child's overall
behavior, breathing patterns and responses to foods
or possible allergy triggers.
Some toddlers are able to use an inhaler containing asthma medication with
a spacer and mask attachment. A spacer is a small tube, or "aerochamber,"
which holds the medication released by the inhaler fitted into it. The
inhaler/spacer device allows children to breathe in the medication at their
own speed plus spacers add to medication possibilities.
Clinical Manifestation
oIncreased respiratory rate
oWheezing (intensifies as attack progresses)
oCough (productive)
oUse of accessory muscles
oDistant breath sounds
oFatigue
oMoist skin
oAnxiety and apprehension
oDyspnea

asthma can be controlled with appropriate treatment and when asthma is

controlled, there should be no more than the occasional flare-up and severe
exacerbations should be rare.
 Nursing Management
1. Assess respiratory status by closely evaluating breathing patterns and
monitoring vital signs
2. Administer prescribed medications, such as bronchodilators,
anti-inflammatory, 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 child’s
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.
The End