UNIVERSITY OF MINDANAO

College of Nursing
Matina, Davao City

Title Page:
Table of Contents:
Acknowledgment:
Introduction:
Objectives of the Study:
•
Identification of the Case:

Patient’s Code Name: Mrs. X

Case No.: 2009040124
Ward: OB Ward
Bed No.: 44
Date of Admission: August 01, 2009
Reason’s of Admission: Labor pain
Date of Discharge (if discharge):
Admitting Diagnosis: S/P 1º LSTCS For CDD; Pregnancy Uterine 37 5/7 weeks
AOG Alpha in Latent Phase of Labor
G2P1 (1001) Cap- Mr , Ba IN AE
Principal Diagnosis: Status Post CS 1 for Cephalopelvic disproportion,
pregnancy uterine term cephalic live birth baby boy G2p2 Intrauterine growth
retardation; with acquired community pneumonia; bronchial asthma in acute
exacerbation
Pre op Diagnosis: S/P LSTCS
Surgical Procedure Performed: LSTCS 11
Date: 08-01-09
Time started: 11:00am
Time ended: 12:20am
Attending Physicians: Dr. Orobello, Dr. Flavier, Dr. Reyna Marie C. Herrera
Date study begun: August 3, 2009
`Date study ended: August 4, 2009
Time spent in actual nursing care to patient: 16 hours
Sources of information/informant/s: Patient, patients husband, patients mother,
patients chart and records
Family Background/ History: (to include history of heredofamilial disease)
Mrs. X is a 35 y.o. female living at Sabang, Poblacion Malita, Davao del
Sur. She has one 8 y.o daughter. She is just a plain housekeeper. Her family is a
protestant. Her family has a history of a respiratory problem. They are known to
be asthmatic. Her family also has a history of kidney failure.
Socioeconomic Background:
Mrs. X is a plain housekeeper, she just stay at home taking good care of her 8
year old girl.

OB-GYNE History: (for female patients)

• Obstetrical Sheet
Obstetrical History G2P2A0
Pregnancy order Pregnancy outcome Year Gestation Completed Wks
/ Delivery
G1____ CS 2002 Full Term (FT)
P2____
Sex: F Present Status
Living
Desired Family Size: 2
Contraceptive history: none
Educational Profession: Secondary
Socio-Economic Prof.: Dependent/unemployed income
Present pregnancy:
LMP: November 2008
EDC: August 16, 2009
AOG: 37 5/7 wks
Menstrual Cycle:
Menarche: 12 y.o. ; Regular; x 4-5 days duration
Antenatal visit: >5
Health Care provider: MCH-DDH-GO
Immunization: TT 1
Medication: Iron Vitamins
+ Cough x 1 week, consulted yesterday at ER given terbutaline and nebulization
as THM
• Department of OB & Gyne (Increase Risk Evaluation Form)
Age: 35 y.o.
Parity: 1
Previous CS: Section 2
TOTAL SCORE: 2
LOW RISK
Antenatal Problems: Respiratory (known asthmatic
Risk Status:
PE: Date 7/31/09 Time: 8:10 PM
Examiner: Dr. Reyna Marie Chua- Herrera, MD
VS as follows:
T: 36.5°C
PR: 68bpm
RR: 22 cpm
BP: 120/80 mmHg
General Status: Well
 Level of Sensorium: HEENT: Ocyctenicsclerae
Conscious
Cooperative
Coherent
Abdomen:
LSK
Fundic Height: 30 cm
Presentation: Cephalic
EFW: 2.6
FHT: 140 bpm
Engagement: Engaged
Pelvic Exam:
External Genitalia: grosly normal
Vagina: grosly normal
Cervix Length: 2 cm
Effacement: 40 %

Medical and Health History/Background:

 History of past illness/es

 History of present illness/es

Developmental Tasks:

Middle Age(30-60)

In the middle years, from about thirty to about fifty-five, women reach the peak of their
influence upon society, and at the same time the society makes its maximum demands
upon them for social and civic responsibility. It is the period of life to which they have
looked forward during their adolescence and early adulthood. And the time passes so
quickly during these full and active middle years that most people arrive at the end of
middle age and the beginning of later maturity with surprise and a sense of having
finished the journey while they were still preparing to commence it.

The biological changes of ageing, which commence unseen and unfelt during the
twenties, make themselves known during the middle years. Especially for the woman, the
latter years of middle age are full of profound physiologically-based psychological
change.

The developmental tasks of the middle years arise from changes within the organism,
from environmental pressure, and above all from demands or obligations laid upon the
individual by his own values and aspirations.

Since most middle-aged people are members of families, with teen-age children, it is
useful to look at the tasks of husband, wife, and children as these people live and grow in
relation to one another. A woman has several functions or roles in the family and these
are being a woman, a wife, a mother, a homemaker and a family manager.

1) Achieving adult civic and social responsibility

2) Establishing and maintaining an economic standard of living
3) Assisting teen-age children to become responsible and happy adults
4) Developing adult leisure-time activities
5) Relating one
2) self to one's spouse as a person
6) Accepting and adjusting to the physiological changes of middle age
7) Adjusting to ageing parents

Definition of terms:
Anatomy and Physiology:

Function of the Respiratory System

The function of the respiratory system is to deliver air to the lungs. Oxygen in the air
diffuses out of the lungs and into the blood, while carbon dioxide diffuses in the opposite
direction, out of the blood and into the lungs. Respiration includes the following
processes:

• Pulmonary ventilation is the process of breathing—inspiration (inhaling air) and

expiration (exhaling air).
• External respiration is the process of gas exchange between the lungs and the
blood. Oxygen diffuses into the blood, while CO2 diffuses from the blood into the
lungs.
• Gas transport, carried out by the cardiovascular system, is the process of
distributing the oxygen throughout the body and collecting CO2 and returning it to
the lungs.
• Internal respiration is the process of gas exchange between the blood, the
interstitial fluids (fluids surrounding the cells), and the cells. Inside the cell,
cellular respiration generates energy (ATP), using O2 and glucose and producing
waste CO2.

Structure of the Respiratory System

The respiratory system

• The nose consists of the visible external nose and the internal nasal cavity. The
nasal septum divides the nasal cavity into right and left sides. Air enters two
openings, the external nares (nostrils; singular, naris), and passes into the
vestibule and through passages called meatuses. The bony walls of the meatuses,
called concha, are formed by facial bones (the inferior nasal concha and the
ethmoid bone). From the meatuses, air then funnels into two (left and right)
internal nares. Hair, mucus, blood capillaries, and cilia that line the nasal cavity
filter, moisten, warm, and eliminate debris from the passing air.
• The pharynx (throat) consists of the following three regions, listed in order
through which incoming air passes:
o The nasopharynx receives the incoming air from the two internal nares.
The two auditory (Eustachian) tubes that equalize air pressure in the
 middle ear also enter here. The pharyngeal tonsil (adenoid) lies at the back
of the nasopharynx.
o The oropharyrnx receives air from the nasopharynx and food from the oral
cavity. The palatine and lingual tonsils are located here.
o The laryngopharynx passes food to the esophagus and air to the larynx.
• The larynx receives air from the laryngopharynx. It consists of the following nine
pieces of cartilage that are joined by membranes and ligaments.

Anterior and sagittal section of the larynx and the

trachea.

o The epiglottis, the first piece of cartilage of the larynx, is a flexible flap
that covers the glottis, the upper region of the larynx, during swallowing to
prevent the entrance of food.
o The thyroid cartilage protects the front of the larynx. A forward projection
of this cartilage appears as the Adam's apple.
o The paired arytenoids cartilages in the rear are horizontally attached to the
thyroid cartilage in the front by folds of mucous membranes. The upper
vestibular folds (false vocal cords) contain muscle fibers that bring the
folds together and allow the breath to be held during periods of muscular
pressure on the thoracic cavity (straining while defecating or lifting a
heavy object, for example). The lower vocal folds (true vocal cords)
contain elastic ligaments that vibrate when skeletal muscles move them
into the path of outgoing air. Various sounds, including speech, are
produced in this manner.
o The cricoid cartilage, the paired cuneiform cartilages, and the paired
corniculate cartilages are the remaining cartilages supporting the larynx.
• The trachea (windpipe) is a flexible tube, 10 to 12 cm (4 inches) long and 2.5 cm
(1 inch) in diameter, whose wall consists of four layers.
o The mucosa is the inner layer of the trachea. It contains mucusproducing
goblet cells and pseudostratified ciliated epithelium. The movement of the
cilia sweep debris away from the lungs toward the pharynx.
 o The submucosa is a layer of areolar connective tissue that surrounds the
mucosa.
o Hyaline cartilage forms 16 to 20 C-shaped rings that wrap around the
submucosa. The rigid rings prevent the trachea from collapsing during
inspiration.
o The adventitia is the outermost layer of the trachea. It consists of areolar
connective tissue.
• The primary bronchi are two tubes that branch from the trachea to the left and
right lungs.
• Inside the lungs, each primary bronchus divides repeatedly into branches of
smaller diameters, forming secondary (lobar) bronchi, tertiary (segmental)
bronchi, and numerous orders of bronchioles (1 mm or less in diameter),
including terminal bronchioles (0.5 mm in diameter) and microscopic respiratory
bronchioles. The wall of the primary bronchi are constructed like the trachea, but
as the branches of the tree get smaller, the cartilaginous rings and the mucosa are
replaced by smooth muscle.
• Alveolar ducts are the final branches of the bronchial tree. Each alveolar duct has
enlarged, bubblelike swellings along its length. Each swelling is called an
alveolus, and a cluster of adjoining alveolar is called an alveolar sac. Some
adjacent alveoli are connected by alveolar pores.
• The respiratory membrane consists of the alveolar and capillary walls. Gas
exchange occurs across this membrane. Characteristics of this membrane follow:
o Type I cells are thin, squamous epithelial cells that constitute the primary
cell type of the alveolar wall. Oxygen diffusion occurs across these cells.
o Type II cells are cuboidal epithelial cells that are interspersed among the
type I cells. Type II cells secrete pulmonary surfactant (a phospholipid
bound to a protein) that reduces the surface tension of the moisture that
covers the alveolar walls. A reduction in surface tension permits oxygen to
diffuse more easily into the moisture. A lower surface tension also
prevents the moisture on opposite walls of an alveolus or alveolar duct
from cohering and causing the minute airway to collapse.
o Alveolar macrophage (dust cells) wander among the other cells of the
alveolar wall removing debris and microorganisms.
o A thin epithelial basement membrane forms the outer layer of the alveolar
wall.
o A dense network of capillaries surrounds each alveolus. The capillary
walls consist of endothelial cells surrounded by a thin basement
membrane. The basement membranes of the alveolus and the capillary are
often so close that they fuse.

Lungs

The lungs are a pair of cone-shaped bodies that occupy the thorax . The mediastinum, the
cavity containing the heart, separates the two lungs. The left and right lungs are divided
by fissures into two and three lobes, respectively. Each lobe of the lung is further divided
into bronchopulmonary segments (each with a tertiary bronchus), which are further
divided into lobules (each with a terminal bronchiole). Blood vessels, lymphatic vessels,
and nerves penetrate each lobe.

Each lung has the following superficial features:

• The apex and base identify the top and bottom of the lung, respectively.
• The costal surface of each lung borders the ribs (front and back).
• On the medial (mediastinal) surface, where each lung faces the other lung, the
bronchi, blood vessels, and lymphatic vessels enter the lung at the hilus.

The pleura is a double membrane consisting of an inner pulmonary (visceral) pleura,

which surrounds each lung, and an outer parietal pleura, which lines the thoracic cavity.
The narrow space between the two membranes, the pleural cavity, is filled with pleural
fluid, a lubricant secreted by the pleura.

Mechanics of Breathing

Boyle's law describes the relationship between the pressure (P) and the volume (V) of a
gas. The law states that if the volume increases, then the pressure must decrease (or vice
versa). This relationship is often written algebraically as PV= constant, or P1V1 = P2V2.
Both equations state that the product of the pressure and volume remains the same. (The
law applies only when the temperature does not change.)

Breathing occurs when the contraction or relaxation of muscles around the lungs changes
the total volume of air within the air passages (bronchi, bronchioles) inside the lungs.
When the volume of the lungs changes, the pressure of the air in the lungs changes in
accordance with Boyle's law. If the pressure is greater in the lungs than outside the lungs,
then air rushes out. If the opposite occurs, then air rushes in. Here is a summary of the
process:

• Inspiration occurs when the inspiratory muscles-that is, the diaphragm and the
external intercostals muscles-contract. Contraction of the diaphragm (the skeletal
muscle below the lungs) causes an increase in the size of the thoracic cavity,
while contraction of the external intercostals muscles elevates the ribs and
sternum. Thus, both muscles cause the lungs to expand, increasing the volume of
their internal air passages. In response, the air pressure inside the lungs decreases
below that of air outside the body. Because gases move from regions of high
pressure to low pressure, air rushes into the lungs.
• Expiration occurs when the diaphragm and external intercostal muscles relax. In
response, the elastic fibers in lung tissue cause the lungs to recoil to their original
volume. The pressure of the air inside the lungs then increases above the air
pressure outside the body, and air rushes out. During high rates of ventilation,
expiration is facilitated by contraction of the expiratory muscles (the intercostals
muscles and the abdominal muscles).
Lung compliance is a measure of the ability of the lungs and thoracic cavity to expand.
Due to the elasticity of lung tissue and the low surface tension of the moisture in the
lungs (from the surfactant), the lungs normally have high compliance.

Lung Volumes and Capacities

The following terms describe the various lung (respiratory) volumes:

• The tidal volume (TV), about 500 ml, is the amount of air inspired during normal,
relaxed breathing.
• The inspiratory reserve volume (IRV), about 3,100 ml, is the additional air that
can be forcibly inhaled after the inspiration of a normal tidal volume.
• The expiratory reserve volume (ERV), about 1,200 ml, is the additional air that
can be forcibly exhaled after the expiration of a normal tidal volume.
• Residual volume (RV), about 1,200 ml, is the volume of air still remaining in the
lungs after the expiratory reserve volume is exhaled.

Summing specific lung volumes produces the following lung capacities:

• The total lung capacity (TLC), about 6,000 ml, is the maximum amount of air that
can fill the lungs (TLC = TV + IRV + ERV + RV).
• The vital capacity (VC), about 4,800 ml, is the total amount or air that can be
expired after fully inhaling (VC = TV + IRV + ERV = approximately 80% TLC).
• The inspiratory capacity (IC), about 3,600 ml, is the maximum amount of air that
can be inspired (IC = TV + IRV).
• The functional residual capacity (FRC), about 2,400 ml, is the amount of air
remaining in the lungs after a normal expiration (FRC = RV + ERV).

Some of the air in the lungs does not participate in gas exchange. Such air is located in
the anatomical dead space within bronchi and bronchioles—that is, outside the alveoli.

Gas Exchange

In a mixture of different gases, each gas contributes to the total pressure of the mixture.
The contribution of each gas, called the partial pressure, is equal to the pressure that the
gas would have if it were alone in the enclosure. Dalton's law states that the sum of the
partial pressures of each gas in a mixture is equal to the total pressure of the mixture.

The following factors determine the degree to which a gas will dissolve in a liquid:

• The partial pressure of the gas. According to Henry's law, the greater the partial
pressure of a gas, the greater the diffusion of the gas into the liquid.
• The solubility of the gas. The ability of a gas to dissolve in a liquid varies with the
kind of gas and the liquid.
• The temperature of the liquid. Solubility decreases with increasing temperature.
Gas exchange occurs in the lungs between alveoli and blood plasma and throughout the
body between plasma and interstitial fluids. The following factors facilitate diffusion of
O2 and CO2 at these sites:

• Partial pressures and solubilities. Poor solubility can be offset by a high partial
pressure (or vice versa). Compare the following characteristics of O2 and CO2:
o Oxygen. The partial pressure of O2 in the lungs is high (air is 21% O2), but
is solubility poor.
o Carbon dioxide. The partial pressure of CO2 in air is extremely low (air is
only 0.04% CO2), but its solubility in plasma is about 24 times that of O2.
• Partial pressure gradients. A gradient is a change in some quantity from one
region to another. Diffusion of a gas into a liquid (or the reverse) occurs down a
partial pressure gradient-that is, from a region of higher partial pressure to a
region of lower partial pressure. For example, the strong partial pressure gradient
for O2 (pO2) from alveoli to deoxygenated blood (105 mm Hg in alveoli versus 40
mm Hg in blood) facilitates rapid diffusion.
• Surface area for gas exchange. The expansive surface area of the lungs promotes
extensive diffusion.
• Diffusion distance. Thin alveolar and capillary walls increase the rate of diffusion.

Gas Transport

Oxygen is transported in the blood in two ways:

• A small amount of O2 (1.5 percent) is carried in the plasma as a dissolved gas.

• Most oxygen (98.5 percent) carried in the blood is bound to the protein
hemoglobin in red blood cells. A fully saturated oxyhemoglobin (HbO2) has four
O2 molecules attached. Without oxygen, the molecule is referred to as
deoxygemoglobin (Hb).

The ability of hemoglobin to bind to O2 is influenced by the partial pressure of oxygen.

The greater the partial pressure of oxygen in the blood, the more readily oxygen binds to
Hb. The oxygen-hemoglobin dissociation curve, shown in Figure 1 , shows that as pO2
increases toward 100 mm Hg, Hb saturation approaches 100%. The following four
factors decrease the affinity, or strength of attraction, of Hb for O2 and result in a shift of
the O2-Hb dissociation curve to the right:
 The oxygen-hemoglobin dissociation curve.

• Increase in temperature.
• Increase in partial pressure of CO2 (pCO2).
• Increase in acidity (decrease in pH). The decrease in affinity of Hb for O2, called
the Bohr effect, results when H+ binds to Hb.
• Increase in BPG in red blood cells. BPG (bisphosphoglycerate) is generated in red
blood cells when they produce energy from glucose.

Carbon dioxide is transported in the blood in the following ways.

• A small amount of CO2 (8 percent) is carried in the plasma as a dissolved gas.

• Some CO2 (25 percent) binds to Hb in red blood cells forming
carbaminohemoglobin (HbCO2). (The CO2 binds to a place different from that of
O2.)
• Most CO2 (65 percent) is transported as dissolved bicarbonate ions (HCO3-) in the
plasma. The formation of HCO3-, however, occurs in the red blood cells, where
the formation of carbonic acid (H2CO3-) is catalyzed by the enzyme carbonic
anhydrase, as follows.

Following their formation in the red blood cells, most H+ bind to hemoglobin molecules
(causing the Bohr effect) while the remaining H+ diffuse back into the plasma, slightly
decreasing the pH of the plasma. The HCO3− ions diffuse back into the plasma as well. To
balance the overall increase in negative charges entering the plasma, chloride ions diffuse
in the opposite direction, from the plasma to the red blood cells (chloride shift).
Control of Respiration

Respiration is controlled by these areas of the brain that stimulate the contraction of the
diaphragm and the intercostal muscles. These areas, collectively called respiratory
centers, are summarized here:

• The medullary inspiratory center, located in the medullar oblongata, generates

rhythmic nerve impulses that stimulate contraction of the inspiratory muscles
(diaphragm and external intercostal muscles). Normally, expiration occurs when
these muscles relax, but when breathing is rapid, the inspiratory center facilitates
expiration by stimulating the expiratory muscles (internal intercostal muscles and
abdominal muscles).
• The pheumotaxic area, located in the pons, inhibits the inspiratory center, limiting
the contraction of the inspiratory muscles, and preventing the lungs from
overinflating.
• The apneustic area, also located in the pons, stimulates the inspiratory center,
prolonging the contraction of inspiratory muscles.

The respiratory centers are influenced by stimuli received from the following three
groups of sensory neurons:

• Central chemoreceptors (nerves of the central nervous system), located in the

medulla oblongata, monitor the chemistry of cerebrospinal fluid. When CO2 from
the plasma enters the cerebrospinal fluid, it forms HCO3- and H+, and the pH of
the fluid drops (becomes more acidic). In response to the decrease in pH, the
central chemoreceptors stimulate the respiratory center to increase the inspiratory
rate.
• Peripheral chemoreceptors (nerves of the peripheral nervous system), located in
aortic bodies in the wall of the aortic arch and in carotid bodies in the walls of the
carotid arteries, monitor the chemistry of the blood. An increase in pH or pCO2, or
decrease in pO2, causes these receptors to stimulate the respiratory center.
• Stretch receptors in the walls of bronchi and bronchioles are activated when the
lungs expand to their physical limit. These receptors signal the respiratory center
to discontinue stimulation of the inspiratory muscles, allowing expiration to
begin. This response is called the inflation (Hering-Breur) reflex.

Etiology and Symptomatology with Scientific Basis:

A bronchial asthma sufferer finds it difficult to breathe because their air passages
feel inflamed and tight. Apart from those symptoms, someone who has bronchial asthma
will also suffer painful wheezing, and long bouts of coughing which brings up mucus.
Alleviating the symptoms is not just a matter of carrying an inhaler around with them all
the time. Asthma attacks can be very awful as bronchial asthma sufferers are all too
aware.
Most asthma sufferers are treated with asthma inhalators, which are devices
fashioned to deliver tiny doses of medications into the respiratory tracts directly, thereby
keeping the systemic side-effects of the medications to the minimum potential. There are
many types of asthma inhalators on the marketplace these days, the most popular being
Ventolin.
Although bronchial asthma has similar symptoms to regular asthma when having
a coughing and wheezing episode, this does not mean they are really having an asthma
attack. As with normal asthma, everyday things like pet dandruff, household dust and
interior mildew can trigger an episode of bronchial asthma. It is always best if you avoid
these types of situation if you have trouble breathing when coming into contact with this
type of situation. Nowadays, excellent face masks are easy to obtain for individual use if
there is a situation where you will come into contact with a household pet that could
trigger he attack. people who struggle with bronchial asthma have severe problems when
trying to run or even when they are under great stress.
Frequently certain foods might be the trigger and cause a mucus increase that
leads to a bronchial attack, usually dairy products, these should be avoided if possible.
Food like milk, bananas, ice cream and other cold food from the refrigerator can often be
the things that exacerbate the condition. If you are unsure what activates your bronchial
asthma you should rule out food products one at a time until you discover the culprits.
Your asthma inhalator should be with you at all times in the event of an attack but
especially if any type of physical exercise is planned.
As there are many ways to help your bronchial asthma condition, you shouldn't
have to live in fear of it because it can be beaten but this necessitates patience and
discipline on your part to pursue easy but good guidelines. Over time you should see an
improvement in your condition which may be because your body adjusts during your life.
If you ensure you carry established medication with you wherever you go, you will feel
more confident and be less likely to have an episode if you have an asthma inhalator or
pills in your pocket or bag.
Pathophysiology: (to include precipitating/ predisposing factors and integration of
the signs and symptoms)
The development of bronchial asthma is a multicausal process, which is caused by
exogenic factors (environmental factors), and also by genetic dispositions. In addition,
the course of the disease can be influenced by climatic changes and mental factors.
Important exogenic activators are: Allergens o Environmental allergens (house dust
mites, pollen) or Allergenic work substances (flour) or Food allergens , toxins or
chemical irritants, respiratory diseases, pseudoallergic reactions (PAR) to analgesics
(analgesic-induced asthma), physical exertion (mainly in children) patients with allergic
asthma or other atopical diseases show a polygenic inherited trait for an overshooting
immune response of IgE. If both parents suffer from atopy, the children have an atopical
disease as well in 40-50% of the cases.
A number of factors can contribute to an asthmatic attack, including allergens,
respiratory tract infections, hyperventilation, cold air, exercise, drugs, and chemicals,
hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.
 Inhalation of allergens is a common cause of asthma. Usually this type of asthma
has its onset in childhood or adolescence and is seen in persons with a family history of
atopic allergy. Persons with allergic asthma often have other allergic diosorders, such as
hay fever, hives, eczema. Attacks are related to exposure to specific allergens. Among
airborne allergens implicated in perennial (year round) asthma are house dust mite
allergens, cockroach allergens, animal danders, and the fungus alternaria.
With bronchial asthma, you may have one or more of the following signs and
symptoms:

• Shortness of breath
• Tightness of chest
• Wheezing

Excessive coughing or a cough that keeps you awake at night

PREDISPOSING FACTORS PRECIPITATING FACTORS

HOST FACTORS: ENVIRONMENTAL FACTORS:

• Indoor allergens
• Genetic predisposition • Outdoor allergens
• Atopy or allergy • Air pollution
• Airway hyperresponsiveness • Respiratory infections
• Gender • Parasitic infections
• Race/ Ethnicity • Socioeconomic factors
• Family size
• Diet and Drugs

Asthma is a chronic disease. It is an inflammatory disorder of the airways in which many

cells and cellular elements play a role. Chronic inflammation causes an associated
increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing,
breathlessness, chest tightness and coughing, particularly at night or in early morning.
The three components which make up the composite course of action in
pathophysiology of bronchial asthma are: airway inflammation, bronchial hyper-
responsiveness and intermittent airflow impediment.
Airway inflammation is caused due to some specific reasons. And these reasons
are a good indicator to whether the asthma is sub-acute, acute or chronic. Some of the
other indicators that assist the diagnosis are the over secretion of mucus, bronchial
reactivity and edema in the air passage: all of which result in obstruction of the sir flow.
Further investigation may reveal permeation of eosnophils in varying degrees, damage of
epithelium and mucus hyper-secretion.
Active T lymphocytes, mast cells, epithelial cells eosnophils and macrophages
etc. can be seen as the reason for airway inflammation in pathophysiology of bronchial
asthma. An examination of epithelial cells, fibroblasts and other air passage cells will
show the severity of the asthma.
Another symptom in pathophysiology of bronchial asthma is the bronchial hyper
activity or hyper-responsiveness to external stimuli. This is measured by causing direct
stimulation of the smooth muscle of the airway as well as through indirect stimulation
with substances from mast cells or other mediator-secreting cells. The results that are
read from the hyper-responsiveness would give the level (severity) of the asthma.
The airflow obstruction is another approach in pathophysiology of bronchial
asthma to evaluate the seriousness of asthma. Obstruction in the airway could be due to a
series of reasons among which could be the edema of the airway, remodeling of the
airway, the formation of a stubborn mucous plug in the airway, acute constriction of the
bronchi, etc. The first asthmatic response, as per the pathophysiology of bronchial asthma
is the acute bronchi-constriction as a reaction to a mediator release which happens when
someone comes into contact with an allergen.
Airway edema follows the process with a minimum and maximum gap of 6 to 24
hours. The mucus plug formation, which is the third component, needs some weeks to
grow and disappear. If no other mode of reversing the obstruction formed in the airway is
found the airway remodeling has to be done, which is the last component.