A Bronchial asthma, commonly known as asthma, is a chronic inflammatory disease of the

airways that causes airway hyperresponsiveness, mucosal edema, and mucus production.
■ is a condition in which the airways narrow and swell and may produce extra mucus. This
can make breathing difficult and trigger coughing, a whistling sound (wheezing) when
breathing out and shortness of breath.
Asthma can be a minor nuisance or a major problem that interferes with daily activities
and may lead to a life-threatening asthma attack.
Asthma can't be cured, but its symptoms can be controlled.
TYPES. The Different types of bronchial asthma are allergic asthma and non-allergic or
Intrinsic asthma.
1. The Allergic asthma is triggered by an allergic reaction from harmless substance.
The Allergic asthma is present in early childhood and adolescence, and is often hereditary.
2. The Intrinsic asthma is present at the age of thirty to forty years.
It is cause by respiratory tract infections, a genetic incompatibility with certain
medications or chemical or toxic substances from the environment (smog, ozone, dust etc.).
TYPES. The Different types of bronchial asthma are the: Exercise-induced asthma,
Occupational asthma, the Allergy-induced asthma.
1. The Exercise-induced asthma is triggered by cold and dry.
2. The Occupational asthma is triggered by workplace irritants such as chemical fumes,
gases or dust.
3. The Allergy-induced asthma is triggered by airborne substances, such as pollen, mold
spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet dander).
CAUSES: The Causes of bronchial asthma are a combination of environmental and
inherited (genetic) factors like for example:
Allergy. Allergy is the strongest predisposing factor for asthma.
Chronic exposure to airway irritants. Irritants can be seasonal (grass, tree, and weed
pollens) or perennial (mold, dust, roaches, animal dander).
Exercise. Too much exercise can also cause asthma.
Stress/ Emotional upset. This can trigger constriction of the airway leading to asthma.
Medications. Certain medications can trigger asthma.

1. The Exposure to various irritants and substances such as the

Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of
cockroach waste.
Morever, it is caused by
2. The Respiratory infections, such as the common cold,
3. The Physical activity,
4. The Cold air, as well as
5. The Air pollutants and irritants, such as smoke.
Likewise,
6. Certain medications, including beta blockers, aspirin, and nonsteroidal anti-
inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium
(Aleve).
Besides, it is caused by
7. Sulfites and preservatives added to some types of foods and beverages, including
shrimp, dried fruit, processed potatoes, beer and wine.
In addition that, asthma is caused by the
8. Strong emotions and stress, and the
9. Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up
into your throat

RISK FACTORS. The Risk factors of Asthma include the following like for example:
1. Having a blood relative with asthma, such as a parent or sibling or
2. Having another allergic condition, such as atopic dermatitis — which causes red, itchy
skin — or hay fever — which causes a runny nose, congestion and itchy eyes
Morever, the risk factors include
3. Being overweight
4. Being a smoker
5. Exposure to secondhand smoke
In addition, they include
6. Exposure to exhaust fumes or other types of pollution
7. Exposure to occupational triggers, such as chemicals used in farming, hairdressing and
manufacturing
SIGNS AND SYMPTOMS
The Bronchial asthma includes three major signs such as
the Airway blockage, the Inflammation,
the Airway irritability.
These problems may cause symptoms like for example:
Coughing
Wheezing or whistling sound when breathing
Shortness of breath
Tightness, pain, or pressure in the chest
Trouble sleeping because of breathing problems

COMPLICATIONS
The Complications for asthma include the following such as:
Status asthmaticus. Airway obstruction in status asthmaticus often results in hypoxemia.
Respiratory failure. Asthma, if left untreated, progresses to respiratory failure.
Pneumonia. Mucus that pools in the lungs and becomes infected can lead to the
development of pneumonia.
MEDICAL MANAGEMENT
Immediate intervention may be necessary, because continuing and progressive dyspnea
leads to increased anxiety, aggravating the situation.

Pharmacologic Therapy
Short-acting beta2 –adrenergic agonists. These are the medications of choice for relief of
acute symptoms and prevention of exercise-induced asthma.
Anticholinergics. Anticholinergics inhibit muscarinic cholinergic receptors and reduce
intrinsic vagal tone of the airway.
Corticosteroids. Corticosteroids are most effective in alleviating symptoms, improving
airway function, and decreasing peak flow variability.
Leukotriene modifiers. Anti Leukotrienes are potent bronchoconstrictors that also dilate
blood vessels and alter permeability.
Immunomodulators. Prevent binding of IgE to the high affinity receptors of basophils and
mast cells.
Peak Flow Monitoring
Peak Flow Meter
Peak Flow Meter. Image via: medlineplus.gov
Peak flow meters. Peak flow meters measure the highest airflow during a forced expiration.
Daily peak flow monitoring. This is recommended for patients who meet one or more of the
following criteria: have moderate or severe persistent asthma, have poor perception of
changes in airflow or worsening symptoms, have unexplained response to environmental or
occupational exposures, or at the discretion of the clinician or patient.
Function. If peak flow monitoring is used, it helps measure asthma severity and, when
added to symptom monitoring, indicates the current degree of asthma control.
Nursing Management
The immediate care of patients with asthma depends on the severity of the symptoms.

Nursing Assessment
Assessment of a patient with asthma includes the following:

Assess the patient’s respiratory status by monitoring the severity of the symptoms.
Assess for breath sounds.
Assess the patient’s peak flow.
Assess the level of oxygen saturation through the pulse oximeter.
Monitor the patient’s vital signs.
NURSING INTERVENTIONS
The nurse generally performs the following interventions:

Assess history. Obtain a history of allergic reactions to medications before administering

medications.
Assess respiratory status. Assess the patient’s respiratory status by monitoring the severity
of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
Assess medications. Identify medications that the patient is currently taking. Administer
medications as prescribed and monitor the patient’s responses to those medications;
medications may include an antibiotic if the patient has an underlying respiratory
infection.
Pharmacologic therapy. Administer medications as prescribed and monitor patient’s
responses to medications.
Fluid therapy. Administer fluids if the patient is dehydrated.
PREVENTION
While there's no way to prevent asthma, you and your doctor can design a step-by-step
plan for living with your condition and preventing asthma attacks.
Follow your asthma action plan. With your doctor and health care team, write a detailed
plan for taking medications and managing an asthma attack. Then be sure to follow your
plan.

Asthma is an ongoing condition that needs regular monitoring and treatment. Taking
control of your treatment can make you feel more in control of your life.

Get vaccinated for influenza and pneumonia. Staying current with vaccinations can
prevent flu and pneumonia from triggering asthma flare-ups.
Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging
from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out
what causes or worsens your asthma, and take steps to avoid those triggers.
Monitor your breathing. You may learn to recognize warning signs of an impending attack,
such as slight coughing, wheezing or shortness of breath.

But because your lung function may decrease before you notice any signs or symptoms,
regularly measure and record your peak airflow with a home peak flow meter. A peak flow
meter measures how hard you can breathe out. Your doctor can show you how to monitor
your peak flow at home.

Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack.
You also won't need as much medication to control your symptoms.
When your peak flow measurements decrease and alert you to an oncoming attack, take
your medication as instructed. Also, immediately stop any activity that may have triggered
the attack. If your symptoms don't improve, get medical help as directed in your action
plan.

Take your medication as prescribed. Don't change your medications without first talking to
your doctor, even if your asthma seems to be improving. It's a good idea to bring your
medications with you to each doctor visit. Your doctor can make sure you're using your
medications correctly and taking the right dose.
Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your
quick-relief inhaler, such as albuterol, your asthma isn't under control. See your doctor
about adjusting your treatment.

Asthma Treatment
Many asthma treatments can ease symptoms and include:
Inhaled corticosteroids. These medications treat asthma in the long term. That means
you’ll take them every day to keep your asthma under control. They prevent and ease
swelling inside your airways, and they may help your body make less mucus. You’ll use a
device called an inhaler to get the medicine into your lungs. Common inhaled
corticosteroids include:
Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Arnuity Ellipta, Armonair Respiclick, Flovent)
Leukotriene modifiers. Another long-term asthma treatment, these medications block
leukotrienes, things in your body that trigger an asthma attack. You take them as a pill
once a day. Common leukotriene modifiers include:
Montelukast (Singulair)
Zafirlukast (Accolate)
Long-acting beta-agonists. These medications relax the muscle bands that surround your
airways. You might hear them called bronchodilators. You’ll take these medications with
an inhaler, even when you have no symptoms. They include:
Ciclesonide (Alvesco)
Formoterol (Perforomist)
Mometasone (Asmanex)
Salmeterol (Serevent)
Combination inhaler. This device gives you an inhaled corticosteroid and a long-acting
beta-agonist together to ease your asthma. Common ones include:
Budesonide and formoterol (Symbicort)
Fluticasone and salmeterol (Advair Diskus, AirDuo Respiclick)
Fluticasone and vilanterol (Breo)
Mometasone and formoterol (Dulera)
Theophylline. It opens your airways and eases tightness in your chest. You take this long-
term medication by mouth, either by itself or with an inhaled corticosteroid.
Short-acting beta-agonists. These are known as rescue medicines or rescue inhalers. They
loosen the bands of muscle around your airways and ease symptoms. Examples include:
Albuterol (Accuneb, ProAir FHA, Proventil FHA, Ventolin FHA)
Levalbuterol (Xopenex HFA)
Anticholinergics. These bronchodilators prevent the muscle bands around your airways
from tightening. Common ones include:
Ipratropium (Atrovent FHA)
Tiotropium bromide (Spiriva)
You can get ipratropium in an inhaler or as a solution for a nebulizer, a device that turns
liquid medicine into a mist that you breathe in through a mouthpiece. Tiotropium bromide
comes in a dry inhaler, which lets you breathe in the medicine as a dry powder.

Oral and intravenous corticosteroids. You’ll take these along with a rescue inhaler during
an asthma attack. They ease swelling and inflammation in your airways. You’ll take oral
steroids for a short time, between 5 days and 2 weeks. Common oral steroids include:
Methylprednisolone (Medrol)
Prednisolone (Flo-pred, Orapred, Pediapred, Prelone)
Prednisone (Deltasone)
You’re more likely to get steroids injected directly into a vein if you’re in the hospital for a
bad asthma attack. This will get the medication into your system more quickly.

■■■■■■■

Diagnosis
First of all, discuss any pre-existing conditions with your doctor as well as any possible
allergies and hereditary predisposition. Precise diagnosis is made after a lung function test
(spirometry). Lung function is examined on the basis of the quantity of inhaled and exhaled
air. The doctor also listens to the lungs to determine the symptomatic breathing sounds.

If spirometry does not produce a clear result, a provocation test also can be carried out. In
order to detect a hypersensitive bronchial system, the patient inhales a test substance. If the
bronchi respond to this stimuli by narrowing, there is a hypersensitivity.

Another investigative procedure is the bronchospasm test. For this, a lung function test is
initially performed. If the bronchi are constricted at this time, the patient inhales a
medication to dilate the bronchi. If the measured value shows an improvement, the
diagnosis is confirmed.
If connection with an allergy is suspected then an allergy test is carried out (blood test with
subsequent skin test).

Other investigations may be performed to exclude other lung diseases.

Treatment – is there a cure for asthma?

Since bronchial asthma is a chronic disease, the main purpose of therapy is to control the
symptoms so that the quality of life of those affected is preserved. With well-adjusted
therapy, patients can remain fully productive.

The treatment of bronchial asthma may be made up of several components.

The ailments are controlled and alleviated with medication. The medication used to treat
asthma can be divided into two groups. Long-term preventative medication are often
referred to as ‘controllers’. An effective long-term treatment method is glucocorticoids.
They inhibit the inflammatory readiness of the bronchi and are preferably administered in
inhaled form so that the dose reaches the respiratory tract immediately.

In the case of an acute asthma attack, soothing medication is available in the form of
‘relievers’. Their aim is to dilate the bronchi as quickly as possible allowing air to flow
again.

Those affected should avoid the factors that trigger asthma attacks as much as possible. In
allergic asthma, hypo-sensitisation also may be performed if the triggering allergens are
known and are not too numerous.

Complementary measures include learning breathing exercises and techniques, practising

sports and seeking a change of climate and psychological support.

Patient training: the affected person and their family can learn to behave correctly in the
event of an asthma attack.

The course of the disease should be monitored constantly by a doctor and the person
concerned.