Lesson Plan on

Asthma
By:

Rabiu Hassan Musa

Definition
Asthma is defined as a chronic
inflammatory
disease of the airways associated with
airway hype responsiveness causing
wide
spread but variable airflow obstruction
within the lungs that is often reversible
either spontaneously or with treatment.
Global Initiative for Asthma
Management (GINA 2010)

Asthma can be defined as a

chronic reactive
airway disorder that involves
episodic,
reversible airway obstruction
resulting from
bronchospasm, increased mucous
secretion
and mucosal edema. It is
characterized by
airway inflammation, intermittent

Epidemiology
In 2005, an estimated 7.7% of the
peoples (22.2 Millions) currently had
asthma.
Rate decreased with age 8.9% of
children (6.5%) had asthma compared
to 7.2% of adults (15.7 Million)

Classification

Intermittent asthma
Mild persistent asthma
Moderate persistent
asthma
Severe persistent asthma

1. Intermittent Asthma

Its an asthma with symptoms of 2 days

per week or less, and night time
awakening twice a month or less
There is no interference with normal
activity
Short acting beta agonists usage for
symptoms control of 2 days a week or
less
Pulmonary function test shows normal
FEV1 between exacerbations

2. Mild persistent Asthma

It has a symptoms of more than twice a

week, but not daily.
Night time awakenings of 3 to 4 times per
month
There is minor limitations of normal activity
Short acting beta agonists usage control
symptoms of more than 2 days a week but not
More than once daily
Pulmonary function test shows FEV1 greater
than 80% predicted. FEV/FVC are normal

3. Moderate persistent

it is an asthma with symptoms every day

Night awakening of more than once a
week but not every night
There is some activity limitations
Short acting beta agonists usage for
symptom control is on daily basis
Pulmonary function test shows FEV1
greater than 60% but less than 80%
predicted. FEV1/FVC reduced 5%

4. Severe persistent
Symptoms is throughout the day
Night time symptoms is 7 times per
week
Activity is extremely limited
Short acting beta agonists usage for
symptom control is several times a day
Pulmonary function test shows FEV1
less
than 60% predicted. FEV1/FVC reduced
more
than 5%

Incidence
It accounts for nearly a half
million
hospitalizations each year
It is more prevalent in African
Americans
than in whites
Death from asthma is more
common in
lower socio-economic groups

Types of asthma

1.Allergic asthma
(extrinsic)
2.Non allergic asthma
(intrinsic)
3.Mixed asthma

1. Allergic asthma (extrinsic)

This occurs in response to

allergens,
such as pollen, dust, spores
and
animal dander

2. Non allergic asthma

(intrinsic)

This is associated with

factors such as
upper respiratory tract
infections,
emotional upsets, and
exercise.

3. Mixed asthma

This is an asthma which

shows the
characteristics of both
allergic and non
allergic asthma

Etiological factors

1. Asthma triggers
2. Cormobidities

1. Asthma triggers
Genetic tendency
Viral respiratory infections
Tobacco smoke
Air pollution
Early use of antibiotics
Sensitization to house dust,
mites
and cockroaches

 Atopy
Exposure to allergens and irritants
Frequent RTIs
Exercise, cold air, strong odors,
perfume, rhinosinusitis, and stress
GERD
Ingestion of sulfites

2. Cormobidities

Drug induced asthma

Allergic reactions such as
eczema,
rashes and temporary
edema
NSAIDs

Pathophysiology

Clinical features

Itching on the neck

Cough
Wheezing
Bronchospasm
Sudden breathlessness
Mucosal edema
Mucus production
Thick secretions
Increased respiratory rate with
use of
accessory muscles

 Prolonged expiration phase

Increased pulse rate
Increased blood pressure
Chest tightness
Diaphoresis
Nasal flaring
Lung hyper inflation
Hype resonance to percussion
Barrel chest

 Decreased breath sounds

Lethargy
Cyanosis
Silent chest
Adventitious breath sound in lung
bases
Respiratory alkalosis
Decreased ability to speak
Status asthmaticus

Diagnostic evaluations

o History collection and Physical examination

o Sputum and blood tests
o Serum IgE level
o ABG and Pulse oxymetry
o Pulmonary Function Test
o Chest X-rays
o Skin allergen testing
o Bronchial challenge testing
o Peak flow monitoring

Management
Medical Management

Adrenergic broncho dilators e.g.

albuterol, metaproterenol
Anti cholinergic e.g. ipratropium,
tiotropium
Methylxanthines e.g. thiophillin,
aminophillin
Corticosteroids e.g. methylprednisolone,
beclomethasone
Mastcell stabilizers e.g. cromolyn
sodium, nedocromil

 Expectorants e.g. robitussin, mucinex

Antileukotrienes e.g. zafirlukast,
montelukast
Antitussives e.g. codeine,
dextromethorpan
Short acting beta agonists e.g.
albuterol (ventolin)
Long acting beta agonists e.g.
formoterol, salmeterol
Monoclonal antibodies e.g. omalizumab
Anti inflammatory e.g. nedocromil
sodium,

Nursing management

Calm approach to reduce the client anxiety

Respiratory status assessment
Obtain history of allergic reactions to
medications before administering any drug
Oxygen administration
Ensure adequate rest and fluid intake
Give prescribed inhalers
Encourage purse lip and diaphragmatic
breathing

 Assist in intubation and

mechanical ventilation if
need be
Perform postural drainage
Suctioning
Maintain temperature

Therapeutic measure and

patients education

1.Self monitoring
2.Avoidance of triggers
3.Medications

Complications
1.Status asthmaticus
2.Others
a.Airway obstruction
b.Asphyxia
c.Exhaustion
d.Atelectesis
e.Pneumothorax
f. Mediastinal and subcuteneous
emphysema
g.Corpulmonale and pneumonia