Bronchial asthma
PICU
OBJECTIVE
1-
Definition of asthma
2- pathophysiology of asthma
3- signs and symptoms
4- treatment of asthma
5- nursing intervention
Asthma
 Is
a chronic inflammation of the small
airway of the lunges that causes them to
be obstructed and therefore air passes
through them less easily .
 It is one of the most common respiratory
conditions affecting children , causing
significant morbidity and mortality
Asthma
 Usually
associated with airflow
obstruction of variable severity
 Airflow obstruction is usually reversible ,
either spontaneously , or with treatment
 The inflammation associated with asthma
causes an increase in the baseline
bronchial hyper responsivness to avareity
of stimuli
ASTHMA TRIGGERS:Dust mites, mold spores, animal dander,
cockroaches , pollen, indoor and outdoor
pollutants , irritants (smoke, perfumes, cleaning
agent)
 Pharmacological agents (ASA, beta blockers)
 Physical triggers (exercise, cold air)
 Physiologic factors (stress, rhinitis, GERD, viral
and bacterial URI (

Signs & Symptoms
Coughing especially at night
Wheezing
Shortness of breath
Chest tightness , pain or pressure
Sneezing
Chin or throat itching
Running nose
Dark circles under eyes
Difficulty talking or concentrating
Decreased or change lung function
What is the Pathophysiology?
 Trigger
Factor
 Mast cell
 Mediators : histamine , prostaglandin,
leukotrienes , as well as cytokines.
 Inflammatory cells
 Sustained Inflammatory response
 Contraction of airway smooth muscles
 ( Bronchoconstriction )
Pathophysiology (Cont.)
 Airway
wall swelling (mucosal edema)
 Airway hyper responsiveness
 Chronic changes
 Hypertrophy of the smooth muscles, thickening
of the basement membrane
 Airway remodeling
 There is good evidence that asthma occurs in
families.
many cells and cellular elements play a
role, in particular, mast cells, eosinophils ,
T lymphocytes, neutrophils and epithelial
cells.
 When mast cells activate, there is
infiltration of inflammatory cells, edema,
denudation and disruption of the bronchial
epithelium, goblet cell hyperplasia and
smooth muscle thickening resulting to
asthmatic inflammation.
HOW TO DIAGNOSE BRONCHIAL
ASTHMA
Consultation skill
 Relevant History
-Symptom
-history of allergic disease
-Family history
-Environmental history
-Exclusion of other medical condition
Diagnosis of B.A ( cont.)
 `Relevant
physical examination
 Investigation
Do you need to do investigation?
Why ?
 Follow up
 Medical record
 Role of Peak Flow Meter
How to manage and control
Bronchial Asthma
 Educate
patients to develop a
partnership in asthma care
 Assess and monitor asthma
severity
 Avoid exposure to trigger factors
 Establish individual medication
plans for long term management
in children and adults
Medical Management:
 Use
of short acting bronchodilator which
is inhaled beta2-agonists as needed for
symptoms with MDI spacer/holding
chamber
 Bronchodilators should be given every 4
to 6 hours for 24 hours for patient with
asthma and viral infection
Rapid reversal of airflow obstruction with
repeated or continuous administration of an
inhaled beta2-agonist; early adminstration of
systemic corticosteroids (eg, oral prednisone or
intravenous methylprednisolone) is suggested
in children with asthma that fails to respond
promptly and completely to inhaled beta2agonists
 Reduction in the likelihood of recurrence of
severe airflow obstruction by intensifying
therapy: Often, a short course of systemic
corticosteroids is helpful
Nursing Management:
Regular monitoring and assessment of
the symptoms in the past 2 weeks.
 Assess for exacerbation, proper
compliance to medications.
 Assess for difficulty with feedings,
changes in respiratory rate, altered
sleep patterns, presence of retractions
 Teach the parents to control or minimize
the exposure to allergens.

* Emphasize the need for flu vaccine for patients
with no restrictions.
 Limit the exposure to cigarette smoke
 Eliminate dust mites
 Encourage to use air conditioners at home and
keep doors and windows closed to minimize
the exposure to these triggers.
 Encourage a regular visit to the physician and
evaluate the proper usage of equipment.
 Provide
a written instruction for
management plans when at home, at
school or care givers.
 Remind the parents or care givers about
the medications, its expiry date as well as
having a reserve of it in times of
exacerbations.
QUESTIONS ????