Definition of Asthma Definition of Asthma

9/22/2015
Asthma
Nursing Care
Ninuk DK
Definition of Asthma
A chronic inflammatory disorder of the airways
Many cells and cellular elements play a role
Chronic inflammation is associated with airway

hyperresponsiveness that leads to recurrent
episodes of wheezing, breathlessness, chest
tightness, and coughing
Widespread, variable, and often reversible

airflow limitation
Global Initiative for Asthma
9/22/2015
Asthma Prevalence and Mortality
Source: Masoli M et al. Allergy 2004
Tujuan Pembelajaran
Memahami Anatomi fisiologi saluran nafas

Menjelaskan Patogenesis Asma
Menjelaskan Patofisiologi Asma
Menjelaskan Asuhan Keperawatan dan
Kolaboratif pasien Asma
9/22/2015
Structures and Functions of the

Respiratory System
Gas Exchange
Ventilation
Diffusion (alveolarcapillary membrane)
Perfusion
Diffusion (capillarycellular level)
9/22/2015
Ventilation
Movement of Chest Wall
Diffusion
Alveolar-Capillary Membrane
9/22/2015
Perfusion
Oxyhemoglobin Curve
9/22/2015
Types of Bronchial Asthma

Extrinsic (atopic, allergic)
Allergens: food, pollen, dust, etc.
Intrinsic (non-atopic)
Initiated by infections, drugs,
pollutants, chemical irritants
Klasifikasi
Asma ekstrinsik
Allergen p.u. diketahui

Test kulit positif
IgE meningkat pada 60% penderita
Onset biasanya pada anak-anak dan dewasa muda
Asma intermitten
Derajat asma bervariasi
Riwayat alergi keluarga positif
9/22/2015
Klasifikasi
Asma intrinsik
Allergen tidak diketahui
Test kulit negatif
IgE normal atau rendah
Onset biasanya pada orang tua
Asma terus menerus
Asma pada umumnya berat
Jarang ada riwayat alergi pada keluarga
Common triggers for asthma
9/22/2015
PATHOLOGICAL BASIS
Hallmark of asthma
Inflammation
Tightening of airway muscles
Mucus secretion
Hyper responsiveness
Airway remodeling
Asthma -
chronic inflammatory disease

reversible airway obstruction
airway remodeling
Asthma Inflammation: Cells and Mediators
Source: Peter J. Barnes, MD
9/22/2015
9/22/2015
Mechanisms: Asthma Inflammation
10
9/22/2015
21
Asthma Inflammation: Cells and Mediators
11
9/22/2015
12
9/22/2015
13
9/22/2015
14
9/22/2015
15
9/22/2015
Kesimpulan
16
9/22/2015
Potential Triggers of Asthma

Allergens 40%
Exercise (EIA)
Air pollutants
Occupational factors
Respiratory infections viral
Chronic sinus and nose problems
Drugs and food additives ASA, NSAIDs, -blockers,
ACEi, dye, sulfiting agents
Gastroesophageal reflux disease (GERD)
Psychological factors- stress
Risk Factors for Asthma
Host factors: predispose individuals to, or

protect them from, developing asthma
Environmental factors: influence susceptibility to

development of asthma in predisposed
individuals, precipitate asthma exacerbations,
and/or cause symptoms to persist
17
9/22/2015
Factors that Exacerbate Asthma
Allergens
Respiratory infections
Exercise and hyperventilation
Weather changes
Sulfur dioxide
Food, additives, drugs
Factors that Influence Asthma

Development and Expression
Host Factors
Genetic
- Atopy
- Airway
hyperresponsiveness
Gender
Obesity
Environmental Factors
Indoor allergens
Outdoor allergens
Occupational sensitizers
Tobacco smoke
Air Pollution
Respiratory Infections
Diet
18
9/22/2015
19
9/22/2015
Epithelial
remodeling
Macrophages
Histamine
Leucotrienes Mast cells
Prostaglandins
Th cells
Eosinophils
Smooth muscle constriction

Th cells
Eosinophil granules release airway

remodeling factors
20
9/22/2015
Epithelial remodeling
CONTROL
Epithelium is damaged
New blood vessels
New muscle
New mucosal cells
Collagen deposition
Epithelial remodeling
Apoptosis
Control
Asthma patient
21
9/22/2015
Loss of columnar cells
Normal
Asthma
patient
Asthma
Signs /Symptoms:
1. Wheezing.
2. Coughing.
3. Dyspnea.
4. Feeling of chest tightness.
44
22
9/22/2015
S & S, cont
Cough
Chest tightness
Wheeze
Dyspnea
Expiration prolonged -1:3 or 1:4, due to
bronchospasm, edema, and mucus
Feeling of suffocation- upright or slightly bent
forward using accessory muscles
Behaviors of hypoxemia- restlessness, anxiety,
HR & BP, PP
23
9/22/2015
Diagnosis Asthma
History and patterns of symptoms
Measurements of lung function
PFTs- usually WNL between a acks; FVC, FEV1
PEFR- correlates with FEV
Measurement of airway responsiveness
CXR
ABGs
Allergy testing (skin, IgE)
24
9/22/2015
25
9/22/2015
Therapeutic Goals of Asthma
No (or minimal)* daytime symptoms

No limitations of activity
No nocturnal symptoms
No (or minimal) need for rescue medication
Avoid adverse effects from asthma medications
Normal lung function
No exacerbation
Prevent asthma mortality
* Minimal = twice or less per week
Asthma Medications
Suppress inflammation
Reverse inflammation
Treat bronchoconstriction
Stop exposure to risk factors that sensitized
the airway
26
9/22/2015
Asthma Medications
Antiinflammatory Agents
Corticosteroids- suppress inflammatory response. Reduce

bronchial hyperresponsiveness & mucus produc on, B2
receptors
Inhaled preferred route to minimize systemic side effects
Teaching
Monitor for oral candidiasis
Systemic many systemic effects monitor blood glucose
Mast cell stabilizers- NSAID ; inhibit release of mediators

from mast cells & suppress other inflammatory cells (Intal,
Tilade)
Asthma Medications
Antiinflammatory Agents
Leukotriene modifiers
Block action of leukotrienes

Accolate, Singulair, Zyflo)
Not for acute asthma attacks
Monclonal Ab to IgE
circula ng IgE
Prevents IgE from attaching to mast cells, thus preventing
the release of chemical mediators
For asthma not controlled by corticosteroids
Xolair SQ
27
9/22/2015
Asthma Medications
Bronchodilators
B-agonists- SA for acute bronchospasm & to

prevent exercised induced asthma (EIA) (Proventil,
Alupent); LA for LT control
Combination ICS + LA B-agonist (Advair)
Methylxanthines- Theophylline: alternative
bronchodilator if other agents ineffective. Narrow
margin of safety & high incidence of interaction
with other medications
Anticholinergics- block bronchoconstriction .
Additive effect with B-agonists (Atrovent)
28
9/22/2015
Asthma
Patient Teaching- Medications
Name/dosage/route/schedule/purpose/SE
Majority administered by inhalation (MDI, DPI,
nebulizers)
Spacer + MDI- for poor coordination
Care of MDI- rinse with warm H2O 2x/week
Potential for overuse
Poor adherence with asthma therapy is challenge for
LT management
Avoid OTC medications
29
9/22/2015
Asthma
Collaborative Care
GINA- decrease asthma morbidity/mortality & improve
the management of asthma worldwide
Education is cornerstone
Mild Intermittent/Persistent: avoid triggers,
premedicate before exercise, SA or LA Beta agonists,
ICS, leukotriene blockers
Acute episode: Oxygen to keep O2Sat>90%, ABGs, MDI
B-agonist; if severe- anticholinergic nebulized w/B
agonist, systemic corticosteroids
30
9/22/2015
31
9/22/2015
Asthma Nursing Diagnoses
Ineffective Airway Clearance

Impaired Gas Exchange
Anxiety
Deficient Knowledge
Nursing Management:
1. Administer prescribed medications, such as antibiotics, cardiac
medications, bronchodilators,mucolytics, corticosteroids and
diuretics as ordered.
2. Administer oxygen to maintain Pao2 of 60 mmHg or Sao2 90%.
3. Monitor fluid balance by intake and output measurement, daily
weight.
4. Perform chest physiotherapy and suctioning to remove mucus. Teach
slow, pursed lip breathing to reduce airway obstruction.
5. If the patient becomes increasingly lethargic, can not cough or
expectorate secretions, can not cooperate with therapy, or if PH falls
below 7.30, despite use of the above therapy, report and prepare to
assist with intubation and initiation of mechanical ventilation.
64
32
9/22/2015
Asthma Management and Prevention

Program: Five Components
1. Develop Patient partnership
2. Identify and Reduce Exposure
to Risk Factors
3. Assess, Treat and Monitor
Asthma
4. Manage Asthma Exacerbations
Updated 2012
5. Special Considerations
Asthma Management and Prevention Program
Goals of Long-term Management
Achieve and maintain control of symptoms

Maintain normal activity levels, including
exercise
Maintain pulmonary function as close to
normal levels as possible
Prevent asthma exacerbations
Avoid adverse effects from asthma
medications
Prevent asthma mortality
33
9/22/2015
Component 1: Develop Partnership
Educate continually
Include the family
Provide information about asthma
Provide training on self-management skills
Emphasize a partnership among health care

providers, the patient, and the patients family
Example Of Contents Of An Action Plan To Maintain Asthma Control

Your Regular Treatment:
1. Each day take ___________________________
2. Before exercise, take _____________________
WHEN TO INCREASE TREATMENT
Assess your level of Asthma Control
In the past week have you had:
Daytime asthma symptoms more than 2 times ?
No
Yes
Activity or exercise limited by asthma?
No
Yes
Waking at night because of asthma?
No
Yes
The need to use your [rescue medication] more than 2 times?
No
Yes
If you are monitoring peak flow, peak flow less than________? No
Yes
If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need to
step up your treatment.
HOW TO INCREASE TREATMENT
STEP-UP your treatment as follows and assess improvement every day:
____________________________________________ [Write in next treatment step here]
Maintain this treatment for _____________ days [specify number]
WHEN TO CALL THE DOCTOR/CLINIC.
Call your doctor/clinic: _______________ [provide phone numbers]
If you dont respond in _________ days [specify number]
______________________________ [optional lines for additional instruction]
EMERGENCY/SEVERE LOSS OF CONTROL
If you have severe shortness of breath, and can only speak in short sentences,
If you are having a severe attack of asthma and are frightened,
If you need your reliever medication more than every 4 hours and are not improving.
1. Take 2 to 4 puffs ___________ [reliever medication]
2. Take ____mg of ____________ [oral glucocorticosteroid]
3. Seek medical help: Go to _____________________; Address___________________
Phone: _______________________
4. Continue to use your _________[reliever medication] until you are able to get medical help.
34
9/22/2015
Factors Involved in Non-Adherence

Medication Usage
Difficulties associated
with inhalers
Complicated regimens
Fears about, or actual

side effects
Cost
Distance to pharmacies
Non-Medication Factors
Misunderstanding/lack of
information
Fears about side-effects
Inappropriate expectations
Underestimation of severity
Attitudes toward ill health
Cultural factors
Poor communication
Component 2: Identify and Reduce

Exposure to Risk Factors
Measures to prevent the development of asthma,
and asthma exacerbations by avoiding or reducing
exposure to risk factors should be implemented
wherever possible.
Asthma exacerbations may be caused by a variety
of risk factors allergens, viral infections,
pollutants and drugs.
Reducing exposure to some categories of risk
factors improves the control of asthma and
reduces medications needs.
35
9/22/2015
Component 2: Identify and Reduce

Exposure to Risk Factors
Reduce exposure to indoor allergens
Avoid tobacco smoke
Avoid vehicle emission
Identify irritants in the workplace
Explore role of infections on asthma

development, especially in children and
young infants
Influenza Vaccination
Influenza vaccination should be
provided to patients with asthma when
vaccination of the general population is
advised
However, routine influenza vaccination
of children and adults with asthma
does not appear to protect them from
asthma exacerbations or improve
asthma control
36
9/22/2015
Component 3: Assess, Treat and

Monitor Asthma
The goal of asthma treatment, to

achieve and maintain clinical control,
can be achieved in a majority of
patients with a pharmacologic
intervention strategy developed in
partnership between the
patient/family and the health care
professional
Global Strategy for Asthma Management and Prevention
Clinical Control of Asthma

The focus on asthma control is
important because:
the attainment of control correlates
with a better quality of life, and
reduction in health care use
37
9/22/2015
Global Strategy for Asthma Management and Prevention
Clinical Control of Asthma

Determine the initial level of
control to implement treatment
(assess patient impairment)
Maintain control once treatment
has been implemented
(assess patient risk)
Levels of Asthma Control

(Assess patient impairment)
Characteristic
Controlled
Partly controlled
(All of the following)
(Any present in any week)
Daytime symptoms
Twice or less
per week
More than
twice per week
Limitations of
activities
None
Any
Nocturnal symptoms
/ awakening
None
Any
Need for rescue /

reliever treatment
Twice or less
per week
More than
twice per week
Lung function
(PEF or FEV1)
Normal
< 80% predicted or

personal best (if
known) on any day
Uncontrolled
3 or more
features of
partly
controlled
asthma
present in
any week
Assessment of Future Risk (risk of exacerbations, instability, rapid

decline in lung function, side effects)
38
9/22/2015
Assess Patient Risk

Features that are associated with increased
risk of adverse events in the future include:
Poor clinical control
Frequent exacerbations in past year
Ever admission to critical care for asthma
Low FEV1, exposure to cigarette smoke,
high dose medications
Component 3: Assess, Treat

and Monitor Asthma
Depending on level of asthma control,
the patient is assigned to one of five
treatment steps
Treatment is adjusted in a continuous
cycle driven by changes in asthma
control status. The cycle involves:
- Assessing Asthma Control
- Treating to Achieve Control
- Monitoring to Maintain Control
39
9/22/2015

and Monitor Asthma
A stepwise approach to pharmacological

therapy is recommended
The aim is to accomplish the goals of

therapy with the least possible medication
Although in many countries traditional

methods of healing are used, their efficacy
has not yet been established and their use
can therefore not be recommended

and Monitor Asthma
The choice of treatment should be guided by:
Level of asthma control
Current treatment
Pharmacological properties and availability

of the various forms of asthma treatment
Economic considerations
Cultural preferences and differing health care

systems need to be considered
40
9/22/2015
Controller Medications
Inhaled glucocorticosteroids
Long-acting inhaled 2-agonists in combination
with inhaled glucocorticosteroids
Systemic glucocorticosteroids
Theophylline
Cromones
Anti-IgE
Estimate Comparative Daily Dosages for

Inhaled Glucocorticosteroids by Age
Drug
Low Daily Dose (g)

>5y
Age
Medium Daily Dose (g)
<5y
>5y
Age
High Daily Dose (g)
<5y
Beclomethasone
200-500
100-200
>500-1000
>200-400
Budesonide
200-600
100-200
600-1000
>200-400
Budesonide-Neb
Inhalation Suspension
Ciclesonide
250-500
80 160
>5y
Age
>1000
>1000
500-1000
<5y
>400
>400
>1000
80-160
>160-320
>160-320
>320-1280
>320
Flunisolide
500-1000
500-750
>1000-2000
>750-1250
>2000
>1250
Fluticasone
100-250
100-200
>250-500
>200-500
>500
>500
Mometasone furoate
200-400
100-200
> 400-800
>200-400
>800-1200
Triamcinolone acetonide
400-1000
400-800
>1000-2000
>800-1200
>2000
>400
>1200
41
9/22/2015
Reliever Medications
Rapid-acting inhaled 2-agonists
Systemic glucocorticosteroids
Anticholinergics
Theophylline
Short-acting oral 2-agonists
Component 4: Asthma Management and Prevention Program
Allergen-specific Immunotherapy
Greatest benefit of specific immunotherapy

using allergen extracts has been obtained in
the treatment of allergic rhinitis
The role of specific immunotherapy in asthma is

limited
Specific immunotherapy should be considered

only after strict environmental avoidance and
pharmacologic intervention, including inhaled
glucocorticosteroids, have failed to control
asthma
Global Initiativephysician
for Asthma
Perform only by trained
42
LEVEL OF CONTROL
REDUCE
9/22/2015
TREATMENT OF ACTION
maintain and find lowest
controlling step
partly controlled
consider stepping up to
gain control
INCREASE
controlled
uncontrolled
exacerbation
step up until controlled

treat as exacerbation
REDUCE
INCREASE
TREATMENT STEPS
STEP
STEP
STEP
STEP
STEP
TO STEP 3 TREATMENT, SELECT

ONE OR MORE:
TO STEP 4 TREATMENT, ADD

EITHER
Shaded green - preferred controller options
43
9/22/2015
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:

EITHER
Treating to Achieve Asthma Control

Step 1 As-needed reliever medication
Patients with occasional daytime symptoms of
short duration
A rapid-acting inhaled 2-agonist is the
recommended reliever treatment (Evidence A)
When symptoms are more frequent, and/or
worsen periodically, patients require regular
controller treatment (step 2 or higher)
44
9/22/2015
SELECT ONE OR MORE:

EITHER

Step 2 Reliever medication plus a single
controller
A low-dose inhaled glucocorticosteroid is
recommended as the initial controller
treatment for patients of all ages (Evidence A)
Alternative controller medications include
leukotriene modifiers (Evidence A)
appropriate for patients unable/unwilling to
use inhaled glucocorticosteroids
45
9/22/2015
SELECT ONE OR MORE:

EITHER

Step 3 Reliever medication plus one or two
controllers
For adults and adolescents, combine a low-dose
inhaled glucocorticosteroid with an inhaled longacting 2-agonist either in a combination inhaler
device or as separate components (Evidence A)
Inhaled long-acting 2-agonist must not be used
as monotherapy
For children, increase to a medium-dose inhaled
glucocorticosteroid (Evidence A)
46
9/22/2015

Additional Step 3 Options for Adolescents and Adults
Increase to medium-dose inhaled

glucocorticosteroid (Evidence A)
Low-dose inhaled glucocorticosteroid
combined with leukotriene modifiers
(Evidence A)
Low-dose sustained-release theophylline
(Evidence B)

ONE OR MORE:

EITHER
47
9/22/2015

Step 4 Reliever medication plus two or more
controllers
Selection of treatment at Step 4 depends

on prior selections at Steps 2 and 3
Where possible, patients not controlled on
Step 3 treatments should be referred to a
health professional with expertise in the
management of asthma

Step 4 Reliever medication plus two or more controllers
Medium- or high-dose inhaled glucocorticosteroid

combined with a long-acting inhaled 2-agonist
(Evidence A)
Medium- or high-dose inhaled glucocorticosteroid
combined with leukotriene modifiers (Evidence A)
Low-dose sustained-release theophylline added
to medium- or high-dose inhaled
glucocorticosteroid combined with a long-acting
inhaled 2-agonist (Evidence B)
48
9/22/2015

ONE OR MORE:

EITHER

Step 5 Reliever medication plus additional controller options
Addition of oral glucocorticosteroids to other

controller medications may be effective
(Evidence D) but is associated with severe
side effects (Evidence A)
Addition of anti-IgE treatment to other
controller medications improves control of
allergic asthma when control has not been
achieved on other medications (Evidence A)
49
9/22/2015
Treating to Maintain Asthma Control

When control as been achieved,
ongoing monitoring is essential to:
- maintain control
- establish lowest step/dose treatment
Asthma control should be monitored

by the health care professional and
by the patient

Stepping down treatment when asthma is controlled
When controlled on medium- to high-dose

inhaled glucocorticosteroids: 50% dose
reduction at 3 month intervals (Evidence
B)
When controlled on low-dose inhaled
glucocorticosteroids: switch to once-daily
dosing (Evidence A)
50
9/22/2015

Stepping down treatment when asthma is controlled
When controlled on combination inhaled

glucocorticosteroids and long-acting
inhaled 2-agonist, reduce dose of inhaled
glucocorticosteroid by 50% while
continuing the long-acting 2-agonist
(Evidence B)
If control is maintained, reduce to lowdose inhaled glucocorticosteroids and
stop long-acting 2-agonist (Evidence D)

Stepping up treatment in response to loss of control
Rapid-onset, short-acting or longacting inhaled 2-agonist

bronchodilators provide temporary
relief.
Need for repeated dosing over more
than one/two days signals need for
possible increase in controller therapy
51
9/22/2015

Stepping up treatment in response to loss of control
Use of a combination rapid and long-acting

inhaled 2-agonist (e.g., formoterol) and an
inhaled glucocorticosteroid (e.g., budesonide)
in a single inhaler both as a controller and
reliever is effecting in maintaining a high level
of asthma control and reduces exacerbations
(Evidence A)
Doubling the dose of inhaled glucocorticosteroids is not effective, and is not
recommended (Evidence A)
Component 4: Manage Asthma

Exacerbations
Exacerbations of asthma are episodes of

progressive increase in shortness of breath,
cough, wheezing, or chest tightness
Exacerbations are characterized by decreases

in expiratory airflow that can be quantified and
monitored by measurement of lung function
(FEV1 or PEF)
Severe exacerbations are potentially lifethreatening and treatment requires close

supervision
52
9/22/2015

Exacerbations
Treatment of exacerbations depends on:

The patient
Experience of the health care professional
Therapies that are the most effective for the particular patient
Availability of medications
Emergency facilities

Exacerbations
Primary therapies for exacerbations:
Repetitive administration of rapid-acting inhaled

2-agonist
Early introduction of systemic

glucocorticosteroids
Oxygen supplementation
Closely monitor response to treatment with serial

measures of lung function
53
9/22/2015
Special Considerations
Special considerations are required to
manage asthma in relation to:
Pregnancy
Surgery
Rhinitis, sinusitis, and nasal polyps
Occupational asthma
Respiratory infections
Gastroesophageal reflux
Aspirin-induced asthma
Anaphylaxis and Asthma
Global Strategy
for the Diagnosis
and Management
of Asthma in
Children 5 Years
and Younger
2009
www.ginasthma.org
54
9/22/2015
Asthma Management and

Prevention Program: Summary
Asthma can be effectively controlled in most

patients by intervening to suppress and reverse
inflammation as well as treating
bronchoconstriction and related symptoms
Although there is no cure for asthma,
appropriate management that includes a
partnership between the physician and the
patient/family most often results in the
achievement of control
Asthma Management and

Prevention Program: Summary
A stepwise approach to pharmacologic therapy is recommended.

The aim is to accomplish the goals of therapy with the least
possible medication
The availability of varying forms of treatment, cultural

preferences, and differing health care systems need to be
considered
55
9/22/2015
Medications to Treat Asthma
Medications come
in several forms.
Two major
categories of
medications are:
Long-term control
Quick relief
Medications to Treat Asthma:

Long-Term Control
Taken daily over a long period of time
Used to reduce inflammation, relax airway

muscles, and improve symptoms and lung
function
Inhaled corticosteroids
Long-acting beta2-agonists
56
9/22/2015

Quick-Relief
Used in acute
episodes
Generally short-acting
beta2agonists

How to Use a Spray Inhaler
The health-care
provider should
evaluate inhaler
technique at each
visit.
Source: What You and Your Family Can Do About Asthma by the Global Initiative for
Asthma Created and funded by NIH/NHLBI
57
9/22/2015

Inhalers and Spacers
Spacers can help patients
who have difficulty with
inhaler use and can reduce
potential for adverse effects
from medication.

Nebulizer
Machine produces a mist

of the medication
Used for small children or

for severe asthma
episodes
No evidence that it is
more effective than an
inhaler used with a
spacer
58

Definition of Asthma Definition of Asthma

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Definition of Asthma Definition of Asthma

Diunggah oleh

Hak Cipta:

Format Tersedia

9/22/2015

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airway

Widespread, variable, and often reversible

Asthma Prevalence and Mortality

Source: Masoli M et al. Allergy 2004

Memahami Anatomi fisiologi saluran nafas

Structures and Functions of the

Movement of Chest Wall

Types of Bronchial Asthma

Allergen p.u. diketahui

Common triggers for asthma

chronic inflammatory disease

Asthma Inflammation: Cells and Mediators

Source: Peter J. Barnes, MD

Mechanisms: Asthma Inflammation

Source: Peter J. Barnes, MD

Asthma Inflammation: Cells and Mediators

Source: Peter J. Barnes, MD

Potential Triggers of Asthma

Risk Factors for Asthma

Host factors: predispose individuals to, or

Environmental factors: influence susceptibility to

Global Initiative for Asthma

Factors that Exacerbate Asthma

Exercise and hyperventilation

Global Initiative for Asthma

Factors that Influence Asthma

Global Initiative for Asthma

Smooth muscle constriction

Eosinophil granules release airway

Loss of columnar cells

Therapeutic Goals of Asthma

No (or minimal)* daytime symptoms

Corticosteroids- suppress inflammatory response. Reduce

Mast cell stabilizers- NSAID ; inhibit release of mediators

Block action of leukotrienes

B-agonists- SA for acute bronchospasm & to

Asthma Nursing Diagnoses

Ineffective Airway Clearance

Asthma Management and Prevention

Asthma Management and Prevention Program

Goals of Long-term Management

Achieve and maintain control of symptoms

Global Initiative for Asthma

Asthma Management and Prevention Program

Component 1: Develop Partnership

Include the family

Provide information about asthma

Provide training on self-management skills

Emphasize a partnership among health care

Example Of Contents Of An Action Plan To Maintain Asthma Control

Global Initiative for Asthma

Asthma Management and Prevention Program

Factors Involved in Non-Adherence

Fears about, or actual

Fears about side-effects

Attitudes toward ill health

Global Initiative for Asthma

Asthma Management and Prevention Program

Component 2: Identify and Reduce

Asthma Management and Prevention Program