Acute asthma for nursing educations.pptx

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1. Asthma Birhanu D ( Bsc , Msc in EM&CCN)

2. INTRODUCTION Definition of Asthma Chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Airway hyper-responsiveness/ bronchoconstriction to a wide range stimuli In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.

3. Cont … These episodes are associated with widespread but variable airflow obstruction that is reversible either spontaneously, or with treatment. Factors contributing to the development of asthma/ early wheezing in children are poorly understood Most common cause of ED visits, hospitalization and missed school days

4. PHASES Early-Phase Response P eaks 30-60 minutes post exposure, subsides 30-90 minutes later Characterized primarily by bronchospasm ,Increased mucous secretion , edema formation, and increased amounts of tenacious sputum Patient experiences wheezing , cough , chest tightness , and dyspnea

5. Cont… Late-Phase Response Characterized primarily by inflammation Histamine and other mediators set up a self-sustaining cycle increasing airway reactivity causing hyper-responsiveness to allergens and other stimuli Increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs If airway inflammation is not treated or does not resolve, may lead to irreversible lung damage

6. Asthma Inflammation – Cells and Mediators

7. Mechanism – Asthma Inflammation Source: Peter J. Barnes, MD

8. Asthma Inflammation

9. Clinical Features Recurrent Wheeze Recurrent Cough Recurrent Breathlessness Activity Induced Cough/Wheeze Nocturnal Cough/Breathlessness Tightness Of Chest Asthma by Consensus, IAP 2003

10. Symptomatology Cough – 90% Wheezing – 74% Exercise induced wheeze or cough – 55% Ind J Ped 2002;69:309-12

11. Typical features of Asthma Afebrile episodes Exercise /Activity induced symptoms History of triggers Seasonal exacerbations Relief with bronchodilators Asthma by Consensus, IAP 2003

12. Diagnosis Good History Taking (ASK) Careful Physical Examination (LOOK) Investigations (PERFORM) CHILDHOOD ASTHMA by KHUBCHANDANI R.P. et al

13. Diagnosing Asthma: Spirometer Testing of lung function is one means of diagnosing asthma .

14. Classifying Severity of Asthma Exacerbations Symptoms and Signs Initial PEF ( Response to Treatment before ED. Mild Dyspnea only with activity PEF 70% predicted Prompt relief with inhaled SABA. Moderate Dyspnea interferes with or limits usual activity PEF 40%–69% predicted Relief from frequent inhaled SABA. Symptoms for 1–2 d after oral corticosteroids begun. Severe Dyspnea at rest; interferes with conversation PEF <40% predicted Partial relief from frequent inhaled SABA. Symptoms for 3 d after oral corticosteroids begun. life-threatening Too dyspneic to speak; perspiring PEF <25% predicted Minimal or no relief from frequent inhaled SABA.

15. Management Of Acute Asthma Aims Of Management To prevent death To relieve respiratory distress         To restore the patient’s lung function to the best possible level as soon as possible. To prevent relapse

16. Management cont… The management depends on the severity of asthma Mild Moderate Severe Normal mental status Agitated Agitated and confused Little or no accessory muscle use Mild to moderate accessory muscle use Significant accessory muscle use So2 >95 % SO2 = 90-95 % So2 <90 Talks in sentences Talks in phrases Talks in single words or unable to talk Wheeze and normal breath sound Wheeze and decrease breath sound Wheeze and significant decreased breath sound or absent breath sounds

17. Asthma Treatments Classified into Controllers and Relievers Controllers – medications to be taken on daily long term basis. - Achieve and maintain control of persistent asthma Relievers – medications to be used on as-needed basis to relieve symptoms quickly/Rescuers/ - Treat symptoms of exacerbations Asthma curable ?

18. Asthma Management Algorithm