ASTHMA

ASTHMAGroup 4Berlin Devina SriyadiDodik FirmansyahEffi MuharyatiEri Lalita DewantiFebrianti Eka WulandariIsnu SafitrianaRifaldi ZulkarnaenVinda Astri Permatasari

DefinitionAsthma is a chronic lung condition that affects the airways. Asthma makes breathing difficult because the airways become swollen, produce too much mucus and the muscles around the airways tighten.Currently there is no cure for asthma, but it can be controlled by routine medical care, which should include a management plan developed by a health care provider, medication(s), avoidance of triggers, and good health habits.

Healthy People 2010, a national health promotion and disease prevention initiative, reports that nationwide, asthma is responsible for 5,000 deaths and 134 million days of restricted activity a year.

Air enters the respiratory system through the nose and mouth. The air is humidified (moistened), filtered and temperature controlled in the nasal cavity and pharynx (passageway from nasal cavity to larynx). The air travels through the larynx (voice box), the trachea (windpipe) and the airways (bronchial tubes or bronchi).EtiologyThe risk factors of asthma include :GeneticsPrenatal risk factorsPrenatal tobacco smokeDiet and nutritionStressMode of delivery

PathophisiologyAirway inflammation. In those with asthma, cells and tissues within the airway are prone to inflammatory reactions against normally harmless substances. This inflammation can cause swelling, mucous production and lead to airway narrowing ( Lemanske ,2010).Airway narrowing. Airway narrowing gives rise to asthma symptoms. When the airways are exposed to substances that trigger a reaction, immunoglobulin E (IgE) antibodies produced by B - cells help facilitate the release of inflammatory mediators including histamine and leukotrienes from mast cells. These mediators cause the airway smooth muscles to contract or spasm, triggering airway narrowing (i.e., bronchoconstriction). Sensory nerves in the muscles become more sensitized, contributing to more bronchospasms (Miller, 2001).Airway remodeling. Structural changes in bronchial tubes can occur with chronic and uncontrolled asthma attacks. For instance, epithelial cells (the layer of cells that line the airways and function as a barrier) can shed, allowing irritants or allergens to further penetrate into the inner muscle cells (James, 2005; Davies, 2009; Campbell, 1997).Sensory nerves can also become exposed leading to reflex neural effects on the airways (Kaufman, 2011).Outlook (Prognosis) of asthma

There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can lead normal lives.Complications

The complications of asthma can be severe, andmay include:DeathDecreased ability to exercise and take part in other activitiesLack of sleep due to nighttime symptomsPermanent changes in the function of the lungsPersistent coughTrouble breathing that requires breathing assistance (ventilator)

Asthma Prevention

If you have asthma, you need to do what you can to reduce your exposure to asthma triggers. Asthma triggers can aggravate your asthma symptoms.Identify triggers for asthma preventionAvoid SmokeMinimize exposure to allergensAvoid coldsAllergy-proof your environmentGet a flu vaccineConsider allergy shots (Immunotherapy)

Tests and diagnosis

Physical exam and interviewTest to measure lung function, may include: SpirometryChecking how much air you can exhale after a deep breath and how fast you can breathe out.Peak flow meterMeasures how hard you can breathe out.Additional tests Methacholine challenge (when inhaled, will cause mild constriction of your airways)Nitric oxide test (measures the amount of the nitric oxide gas, in your breath)Imaging tests (A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses))Allergy testing (by skin test or blood test)Sputum eosinophils (present when symptoms develop and become visible when stained with a rose-colored dye (eosin))Provocative testing for exercise and cold-induced asthma

Nursing Management

The nurse assesses the patients respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.The nurse obtains a history of allergic reactions to medications before administering medications and identifies the patients current use of medications. The nurse administers medications as prescribed and monitors the patients responses to those medications. Fluids may be administered if the patient is dehydrated, and antibiotic agents may be prescribed if the patient has an underlying respiratory infection. Give patient 3 liters/day of fluid to help liquefy any secretions.If the patient requires intubation because of acute respiratory failure, the nurse assists with the intubation procedure, continues close monitoring of the patient, and keeps the patient and family informed about procedures.Administer supplemental oxygen to help meet bodys needs.Identify and remove allergens and known triggers to avoid causing an asthma attack.Medical management (Pharmacologic therapy)

Administer short-acting beta 2 -adrenergic drugs to bronchodilate: albuterol, pirbuterol, metaproterenol, terbutaline, levalbuterolAdminister long-acting beta 2 -adrenergic drugs to manage symptoms day to day; keep airways open, not for acute symptoms: salmeterol, formoterolAdminister leukotriene modulators to reduce local inflammatory response in lung to reduce exacerbations; does not have immediate effect on symptoms: zafirlukast, zileuton, montelukastAdminister anticholinergic drugs ipratropium inhaler, tiotropium handihalerAdminister antacid, H2 blocker, or proton pump inhibitor to decrease the amount of acid in the stomach, reducing the possibility of ulcers due to stress of disease or medication effects.Antacids: aluminum hydroxide/magnesium hydroxide, calcium carbonateH2 blockers: ranitidine, famotidine, nizatidine, cimetidineProton pump inhibitors: omeprazole, lansoprazole, esomeprazole, rabeprazole, pantoprazoleAdminister mast cell stabilizer to retain an early component of the initial response to allergens, which will prevent further reactions from occurring; this is not for acute symptoms. This is useful for pretreatment for allergen exposure or chronic use to improve control of symptoms. cromolyn, nedocromilAdminister steroids to decrease inflammation, which will help open airways; these are not for acute symptoms : hydrocortisone, methylprednisolone intravenously, beclomethasone, triamcinolone, fluticasone, budesonide, flunisolide, mometasone inhalers, prednisolone, prednisone orallyAdminister methylxanthines to assist with bronchodilation, often used when other medications not effective : aminophylline, theophylline.

References

American Academy of Allergy, Asthma and Immunology. 2002. Exercise-Induced Asthma.American Academy of Allergy, Asthma and Immunology. 2003. National Allergy Bureau.American Academy of Allergy, Asthma and Immunology. 2003. Tips to Remember: Exercised-Induced Asthma.http://www.aaaai.org/nab.http://www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stmhttp://www.aaaai.org/patients/topicofthemonth/0202default.stmhttp://www.webmd.com/asthma/guide/asthma-preventionSmeltzer C.S and Bare Brenda. Brunner and Suddarths Textbook of Medical Surgical Nursing 10th edition. Lippincott Williams & Wilkins