ASTHMA
DEFINITION
Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction, and bronchospasm.
Although asthma is a chronic obstructive condition, it is not considered as a part of chronic obstructive pulmonary disease as this term refers specifically to combinations of bronchiectasis,chronic bronchitis, and emphysema. Unlike these diseases, the airway obstruction in asthma is usually reversible; however, if left untreated, asthma can result in chronic inflammation of the lungs and irreversible obstruction.
SIGN AND SYMPTOMS
Common symptoms of asthma include wheezing, shortness of breath, chest tightness and coughing. Symptoms are often worse at night or in the early morning, or in response to exercise or cold air.
ASTHMA ATTACK
Severity of acute asthma exacerbations[19]
Near-fatal asthma High PaCO2 and/or requiring mechanical ventilation
Life threatening asthma Any one of the following in a person with severe asthma:-
Clinical signs Measurements
Altered conscious level
Peak flow
Exhaustion Oxygen saturation
Arrhythmia
PaO2
Low blood pressure
“Normal” PaCO2
Cyanosis
Silent chest
The Essay on Asthma A Respiratory Disease
Asthma (A Respiratory Disease) The word asthma come from the Greek term meaning panting. Asthma is respiratory disease usually caused by allergic reaction of dust, pollen, animal fur, feather, and mold. The disease usually causes spasm and constriction of the bronchial passage which results in making it harder for air to pass. Asthma caused from allergies and is also called atopic or extrinsic. ...
Poor respiratory effort
acute severe asthma Any one of:-
Peak flow 33-50%
Respiratory rate ≥ 25 breaths per minute
Heart rate ≥ 110 beats per minute
Unable to complete sentences in one breath
Moderate asthma exacerbation Worsening symptoms
Peak flow > 50% best or predicted
No features of acute severe asthma
An acute exacerbation of asthma is commonly referred to as an asthma attack. The cardinal symptoms of an attack are shortness of breath (dyspnea), wheezing, and chest tightness. Although the former is often regarded as the primary symptom of asthma. some people present primarily with coughing, and in the late stages of an attack, air motion may be so impaired that no wheezing is heard.[19]When present the cough may sometimes produce clear sputum. The onset may be sudden, with a sense of constriction in the chest, as breathing becomes difficult and wheezing occurs (primarily upon expiration, but sometimes in both respiratory phases).
It is important to note inspiratory stridor without expiratory wheeze however, as an upper airway obstruction may manifest with symptoms similar to an acute exacerbation of asthma, with stridor instead of wheezing, and will remain unresponsive to bronchodilators.
Signs of an asthmatic episode include wheezing, prolonged expiration, a rapid heart rate (tachycardia), and rhonchouslung sounds (audible through a stethoscope).
The affected patient may also appear pale. During a serious asthma attack, the accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck) may be used, shown as in-drawing of tissues between the ribs and above the sternum and clavicles, and there may be the presence of a paradoxical pulse (a pulse that is weaker during inhalation and stronger during exhalation), and over-inflation of the chest.
During very severe attacks, an asthma sufferer’s face and fingernails can turn blue from lack of oxygen, and can experience chest pain or even loss of consciousness. A patient’s fingernails may also turn purple due to a lack, or low amount of oxygen circulating through the bloodstream. Just before loss of consciousness, there is a chance that the patient will feel numbness in the limbs and palms may start to sweat. The person’s feet may become cold. severe asthma attacks which are not responsive to standard treatments, called status asthmaticus, are life-threatening and may lead to respiratory arrest and death. Though symptoms may be very severe during an acute exacerbation, between attacks a patient may show few or even no signs of the disease.
The Essay on Asthma Attacks Breathing Children
... asthma attack begins within minutes after exposure to a triggering agent. Symptoms include a sensation of tightness in the chest, coughing and wheezing, ... narrowing of the bronchi, the airways branching from the trachea to the lungs. Attacks usually are brought on by ... and difficulty in breathing. Persons having attacks usually find it more difficult to exhale then inhale, which ...
PATHOPHYSIOLOGY
Asthma is an airway disease that can be classified physiologically as a variable and partially reversible obstruction to air flow, and pathologically with overdeveloped mucus glands, airway thickening due to scarring and inflammation, and bronchoconstriction, the narrowing of the airways in the lungs due to the tightening of surrounding smooth muscle. Bronchial inflammation also causes narrowing due to edema and swelling caused by an immune response to allerg
DRUG THERAPY
• Oxygen therapy will help normalize oxygen content while fixed airway obstruction related to airway inflammation and ventilation-perfusion mismatching resolve. This reduces the catecholamine response that can cause tachycardia and increased blood pressure.
• Inhaled ß2-agonists produce the most rapid relief from acute bronchospasm with the fewest side-effects. Before treatment with inhaled ß2-agonists (using a metered-dose inhaler [MDI] or wet nebulizer) does not preclude successful reversal of airflow limitation in the emergency department.
• Salbutamol is more effective and safer when inhaled than when taken intravenously. Intravenous use of bronchodilators should be considered only if the response to the inhaled drug is poor or if the patient is coughing excessively, is moribund or becomes so despite inhalation therapy.
• The dosage of inhaled bronchodilators should be adjusted based on objective measures of airflow limitation and symptoms. It may be necessary to increase the dose to 1 puff every 30-60 seconds. There may not be a maximum dose, depending on the response to treatment, but some have suggested that 20-40 puffs may be required. Sometimes continuous wet nebulizer treatment is indicated. Relief of bronchospasm with inhaled bronchodilators is best achieved if the principle of cumulative dosing is followed: sequential doses build on the therapeutic effects of previously administered doses. Prehospital treatment with inhaled ß2-agonists (using an MDI or a wet nebulizer) does not preclude successful reversal of airflow obstruction in the emergency department.
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Depression in school-age children may be one of the most overlooked and under treated psychological disorders of childhood, presenting a serious mental health problem. Depression in children has become an important issue in research due to its many emotional forms, and its relationship to self-destructive behaviors. Depressive disorders are of particular importance to school psychologists, who are ...
• Once a plateau is achieved (i.e., no further improvement noted after subsequent doses), continued administration of bronchodilators by any route is not likely to provide further clinical benefit and may result in toxic effects. Patients with severe asthma (i.e., FEV1 or PEF
