Bronchial Asthma - Masteral

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Bronchial Asthma (Alteration in Oxygenation)

Niña Alma M. Bianson RN Lyceum of the Philippines University Batangas City 04/13/09

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Objectives: 

At the end of the discussion the students will be able to:  

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Define Bronchial Asthma Discuss the anatomy and physiology of the respiratory system Discuss the pathophysiology of bronchial asthma State the different medical management for bronchial asthma Shashi

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Diagnosis: Bronchial Asthma An 18 year old girl was brought to the clinic for complaints of Bronchial Asthma. When patient reported to us, she was having a very severe attack of Asthma. She complained of breathlessness that was worse from cold drink, cold water, draft of air, monsoon, getting wet, at midnight. Her complaints were better during the dry climate and when traveling out of Philippines. The complaints would also be relieved by taking warm drinks and tea. 04/13/09

Shashi

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Diagnosis: Bronchial Asthma The cough was productive with white expectoration. The patient's peculiar features at the time of the Asthma attack were extreme anxiety and fear of death. She felt thirsty for little water at a time. She was feeling sensitive to cold and extremely restless due to the complaints. The patient also had complaints of cold with watery discharge from the nose and cracking of the joint 04/13/09 Shashi accompanied by pain.

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Diagnosis: Bronchial Asthma She had a normal appetite with liking for sweets, fast food and tea and was averse to eating vegetables. She would occasionally be constipated. Her sweat was profuse in the summers, especially in underarms. Her sleep would be frequently disturbed due to the asthma attacks and due to thoughts on her mind. 04/13/09

Shashi

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Diagnosis: Bronchial Asthma Her birth history was normal. Birth weight: 8 pounds Age of talking: 1 year Age of teething: 8 months

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Shashi

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Asthma: 

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Chronic Inflammatory disorder of bronchi characterized by Episodic, reversible bronchospasm resulting from an exaggerated bronchoconstrictor response to various stimuli (allergy) Affects 10% of children & 5%-7% adults ♥

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Asthma Facts ? Asthma is “all in the mind.”  You will “grow out of it.”  Asthma can be cured,  Not very serious disease and nobody dies from it.  You are likely to develop asthma if someone in your family has it.  You can “catch” asthma from someone else who has it.  Moving to a different location can cure asthma.  People with asthma should not exercise.  Asthma does not require medical treatment.  Medications used to treat asthma are habitforming.  Someone with asthma can provoke episodes anytime. 04/13/09  Asthma can spread to other persons through Shashi 

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Percent Change in AgeAdjusted Death Rates, U.S., 1965-1998

Proportion of 1965 Rate 3.0 2.5

Coronary Heart Disease

Stroke

Other CVD

COPD

All Other Causes

–59%

–64%

–35%

+163%

–7%

2.0 1.5 1.0 0.5 0

1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998

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Anatomy Physiology

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Human Respiratory System The human respiratory system consists of two lungs and a set of air passages. The lungs, together with the heart, sit in the thoracic cavity or chest. This is an air tight cavity that:  provides a large surface area for gas exchange  has moist gas exchange surface areas  is associated with the circulatory system to transport oxygen to the cells and pick up carbon dioxide produced by every cell 04/13/09 

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..continuation of Anatomy The main function of the respiratory system is to move air into the lungs so that oxygen can enter the body and carbon dioxide can be exhaled. During breathing, air passes from the nose and mouth into the pharynx and through the larynx into the trachea. The trachea bifurcates to carry air into each lung. These two tubes are the main stem bronchi; there is a single left main stem bronchus and a single right main stem 04/13/09 bronchus for the left and right lungs,Shashi 

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Anatomy and Physiology

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Asthma

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Pathophysiolo gy:

Airway Hyperresponsiveness Genetic*

INDUCERS Allergens,Chemical sensitizers, Air pollutants, Virus infections

INFLAMMATION Airflow Limitation

TRIGGERS Allergens, Exercise, Cold Air, SO2 Particulates

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SYMPTOMS Cough Wheeze Dyspnea Shashi

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Causal Factors Predisposing Factor >Exposure to indoor Atopy And outdoor allergens Female gender >Occupational sensitizers

Contributing Factors >Respriratory infections >Air pollution >Active/passive smoking >Others diet, small size at birth

Inflammation Hyperresponsiveness of airways

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Risk Factors for Exacerbations Allergens Respiratory infections Exercise and hyperventilation Weather changes Exposure to sulfur dioxide Exposure to food, additives, medications

Airflow limitation

Symptoms Wheezing Cough Dyspnea Chest tightness

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Pathogenesis - Atopic Asthma:

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Mast cells in Asthma Pathogenesis:

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Eosinophils in Asthma Pathogenesis:

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Lung Morphology in Asthma 

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Bronchial inflammation Edema, Mucousplugging Bronchospasm Obstruction Over inflation/Atelectasis COPD Shashi

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Lung Hyperinflation in Asthma

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Thick bronchi with Mucous plugs

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Asthma Microscopic Pathology Obstructed Inflammed Bronchi

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Asthma - Bronchial morphology   

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inflammation Eosinophils Gland hyperplasia Mucous plug in lumen Hypertrophy of muscle layer Shashi

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Asthma - Bronchial morphology 

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Inflammatio n Mucous Plug Eosinophils

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Asthma – TH2 lymphocytes immunostaining)

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Mucous plug in asthma:

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Eosinophils in Asthma:

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Medical Management There are two basic kinds of medication for the treatment of asthma:  Long-term control medications  Quick relief (rescue) medications 04/13/09

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Long-term control medications

-- used on a regular basis to prevent attacks, not for treatment during an attack.  inhaled steroids (e.g., Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation  leukotriene inhibitors (e.g., Singulair, Accolate)  long-acting bronchodilators (e.g., famoterol, Serevent) help open airways  cromolyn sodium (Intal) or nedocromil sodium  aminophylline or theophylline (not used as frequently as in the past)  combination of anti-inflammatory and bronchodilator, using either separate inhalers or a single inhaler (Advair Diskus)

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Quick relief (rescue) medications

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-- used to relieve symptoms during an attack.  short-acting bronchodilators (e.g., Proventil, Ventolin, Xopenex, and others)  oral or intravenous corticosteroids (e.g., prednisone, methylprednisolone) stabilize severe episodes

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New Pathology & Drugs in Asthma:

Leukotriences - significant role in Asthma  Mast cells and Eosinophil - Cytokines.  Arachidonic acid - Lipo-oxygenase – LTD4  Bronchospasm – Cys-LT1 receptor  Zileuton – Lipoxygenase inhibitor  Montelukast & zafirlukast - inhibit CysLT1 04/13/09 

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Cell Damage Cell Membrane Phospholipids

5-Lipoxygenase

Steroids

Arachidonic Acid

Cyclooxygenas e NSAID

Leukotrienes

Prostaglandins

LTC4, D4, E4

Prostacyclins

5-LO inhibitors Antileukotrienes 04/13/09

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The Reality   

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Asthma is not yet curable * Underdiagnosis & Undermanagement Therapy is still evolving

Hope  Better understanding of Pathology  New line of Promissing Drugs. 04/13/09 Proper management  normalShashi 

Thank You…

Niña Alma M. Bianson RN Lyceum of the Philippines University Batangas City 04/13/09

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References Joyce Black, Medical and Surgical Nursing, 8th edition, 2005  Saunder’s, Comprehensive Review for NCLEX, 2006  Brunner And Suddarth, Medical and Surgical Nursing, 6th Edition, 2005  Berto, J.M.; Pelaez, A.; Fernandez E; A new indoor source of Allergic sensitization & respiratory disease. Allergy, 2002, 57, 155-159  Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. Vol. 1, 3rd ed. Philadelphia, Pa.: W.B. Saunders; 2000.  Shier D, Butler J, Lewis R. Hole's Human Anatomy and Physiology. 7th ed. Dubuque, Iowa: William C Brown Publishers; 1996. 04/13/09  www.allrefer.com Shashi 