What is Asthma?

Asthma is a long-term disease that affects both children and adults. The condition is characterized by the narrowing of the airways due to inflammation, swelling, and tightening of surrounding muscles. The airways may also produce extra mucus resulting in difficulty breathing. For some people, asthma is a minor condition, while in some, it is a significant condition that affects/interferes with daily activities making it life-threatening. Patients with asthma may be free from symptoms, with these periods alternating with acute flare-ups that last from minutes to days. Asthma has no cure but can be controlled.

Pathophysiology of Asthma

Asthma’s pathophysiology is reversible by diffusing inflammation that causes the narrowing of the airways. The pathophysiology of asthma includes:

• Activation. The activation of mast cells leads to the release of inflammatory mediator chemicals, including histamine, into the bloodstream.
• Perpetuation. The released chemicals perpetuate inflammation making the blood vessels narrow as the surrounding tissues swell. This constricts blood vessels causing increased blood flow. In addition, fluid leaks from the vasculature and attracts white blood cells (WBCs) to the area.
• Bronchoconstriction. Allergen-related bronchoconstriction occurs following the release of mediator chemicals from mast cells. This may lead to mucus buildup in the airways causing the airways to contract and become narrower.
• Progression. Asthma becomes more persistent as inflammation continues. Various factors could be involved in limiting airflow, worsening the asthma attack.

Statistics and Epidemiology of Asthma

Asthma is the most common long-term childhood disease that disrupts life affecting school and work attendance. About 262 million people live with asthma worldwide, with over 455 000 dying annually due to asthma-related causes. In addition, about 24 million people live with asthma in the US (about 1 in every 13 people), with about 497,000 annual hospitalizations costing the economy over $27 billion.

In addition, data shows that about 11 people die from asthma in the US, adding up to more than 4,000 deaths per year. Epidemiological data also shows that Black adults have the highest asthma rates in the US, with female adults being affected more than males. However, the condition is more common in male children than female children.

Causes of Asthma

Regardless of the increased knowledge of asthma pathology, medications, and management, hospitalization, and death rates continue to rise. Asthma has various causes that predispose individuals to the condition, including:

• Allergy. This is the biggest predisposing factor for the disease.
• Exposure to airway irritants. Irritants could include indoor irritants such as mold, fungi, dust mites, cat fur, dust, cockroaches, cold air tobacco, and stress. Outdoor irritants such as grass, weed, and other pollen could also trigger asthma.
• Exercise. Too much exercise, especially during cold weather, could induce asthma.
• Occupational irritants. Other irritants at work, such as dust, gases, fumes, and chemicals, could cause asthma.
• Emotional upset and stress. This can cause bronchoconstriction leading to asthma.
• Medications or supplements. Various drugs such as aspirin, NSAIDs, Beta blockers, and angiotensin-converting enzyme inhibitors can trigger asthma symptoms.

Clinical Manifestations of Asthma

The signs and symptoms of asthma are easy to identify and require one to immediately seek medical attention. They include

• Coughing. This is the most common symptom of asthma which may occur with or without the production of mucus.
• It mainly occurs during expirations (exhaling), especially in children.
• Tightness of the chest may lead to shortness of breath or a feeling of suffocation.
• Difficulty sleeping. This may be due to shortness of breath, wheezing, and coughing.
• Allergic reactions. Temporary edema, rashes, and eczema may be noted in asthma patients.

The signs and symptoms that indicate exacerbation and worsening of asthma include:

• More frequent, prolonged, and bothersome signs and symptoms
• Increased difficulty breathing.
• Additional symptoms, such as tachycardia and diaphoresis, may occur.
• Status asthmaticus, characterized by hypercarbia, hypoxemia, and secondary respiratory failure, indicates severe acute asthma.

Prevention of Asthma

Undergoing tests is necessary for asthma patients to help identify substances triggering the symptoms. Although there is no way to prevent asthma, one can take measures to live with the condition and avoid asthma attacks. Prevention of asthma includes:

• Avoiding allergens. Seasonal and perennial allergens, such as dust mites, animal fur, and mold, can be avoided.
• Regularly washing bedding and cleaning seats and carpets can help eliminate irritating dust.
• Avoid stress and anxiety. This can be done by using relaxation techniques or seeking professional help to address stress.
• Avoid smoking tobacco. Smoking tobacco could trigger asthma attacks hence the need to avoid smoking.
• Getting influenza and pneumonia vaccination to prevent triggering asthma flare-ups.
• Identify and treat attacks early to prevent severe attacks. Monitory your breathing to recognize signs of an incoming attack.
• Take medication as prescribed.

Asthma Complications

The complications of asthma include:

• Status asthmaticus. This is a severe form of asthma characterized by hypercarbia and hypoxemia, indicating severe asthma exacerbation.
• Respiratory failure. If left untreated, asthma could progress to respiratory failure making it difficult to breathe on your own.
• Pneumonia. The infection due to mucus pooling in the lungs can lead to the development of pneumonia

The Assessment of Asthma and Diagnostic Findings

Determining the diagnosis of asthma requires the clinician to establish that airway obstruction is present.

• Physical exam. This can help the clinician rule out other potential diagnoses, such as respiratory infections.
• Spirometry. This test can help estimate a possible narrowing of airways by measuring the amount of air inhaled and exhaled after a deep breath, including how quickly you breathe out.
• Peak flow. This test measures the speed at which one exhales. Low peak flow may indicate worsening asthma.
• Methacholine challenge. This is an asthma trigger given to establish if one reacts to methacholine, indicating one has asthma.
• Imaging tests. Tests such as a chest X-ray can be used to identify structural abnormalities in the lungs causing breathing difficulties.
• Allergy testing. This is performed through blood or skin test to establish if one is allergic to mold, pollen, dust, or pets.

Medical Management of Asthma

Pharmacologic Therapy

The right medication for asthma depends on the symptoms severity, age, and asthma triggers, among other factors.

• Quick Relief Medications. They provide quick relief by quickly opening swollen airways to allow breathing. They include:
  • Short-acting beta-agonists. They are quick relief bronchodilators such as albuterol and levalbuterol, inhaled to provide relief within minutes.
  • Anticholinergics agents. They act quickly, relaxing the airways to make it easier to breathe. They include tiotropium and ipratropium.
  • Oral and IV corticosteroids. They include methylprednisolone and prednisone. They help relieve inflammation of the airways caused by severe asthma.
• Long-term medication. These drugs are taken daily to control asthma by reducing inflammation that leads to asthma symptoms. They include:
  • Inhaled Corticosteroids. They include medications such as budesonide, beclomethasone, fluticasone propionate, and ciclesonide.
  • Leukotriene modifiers. They include zileuton and zafirlukast, which help relieve symptoms.
  • Combination inhalers. Contain a combination of different classes of drugs, such as long-acting beta-agonist and corticosteroids.
  • Theophylline. The pill is administered to help relax airway muscles and keep the airway open.
• Allergy Medications. These are prescribed to patients with allergy-triggered asthma. They include:
  • Allergy shots. Also called Immunotherapy includes shots given over a period of time.
  • They include reslizumab, omalizumab, and others given to people with severe asthma.

Peak Flow Monitoring

This involves using a peak flow meter to measure how fast one exhales. It is recommended for patients with severe asthma to help monitor progress. For instance, low peak flow may indicate worsening asthma.

Nursing Management of Asthma

The nursing care of patients with asthma depends on the severity of asthma symptoms. Nursing management includes the following:

Nursing Assessment of Asthma

The assessment of asthmatic patients includes the following:

• Monitor the severity of symptoms.
• Assess the patient for breathing sounds (wheezing).
• Assess oxygen saturation level.
• Assess the peak flow.
• Monitor the patient’s vital signs

Nursing Diagnosis of Asthma

The nursing diagnosis for asthma patients includes:

• Ineffective airway clearance due to overproduction and accumulation of mucus and bronchospasm.
• Impaired gas exchange related to airway obstruction and shortness of breath.

Nursing Care Planning and Goals for Asthma Patients

The nurse should apply the following goals to treat an asthma patient successfully.

• Maintain patency of the airway
• Maintain expulsion or expectoration of mucus
• Reduce congestion by keeping breath sounds clear/noiseless and improving oxygen exchange.
• Demonstrate approaches to improve and maintain a clear airway
• The patient should verbalize an understanding of asthma causes and management regimen.
• Identify potential complications and corrective actions.

Nursing Interventions for Asthma

The nurse should perform the following interventions.

• Assess the patient’s allergic history.
• Assess respiratory status.
• Administer the prescribed medication.
• Assess how the patient responds to the medication.
• Administer fluids in case of dehydration.

Nursing Evaluation of Asthma Patient

The nurse evaluation is performed to determine the effectiveness of the care plan. The patient is evaluated for:

• Maintained airway patency.
• Continued expulsion of secretions (mucus).
• Absence or reduced congestion with clear/noiseless breathing.
• Verbalized understanding of asthma causes and therapeutic management regimen.
• Maintained clear airway
• Identified complications and initiated corrective actions.

Nursing Discharge and Home Care Guidelines

The discharge guidelines for an asthma patient/caregiver include the following:

• Teach the need for collaboration between the patient and healthcare provider to effectively treat asthma at home.
• Teach the patient, caregiver, and family about asthma, medication, and triggers to avoid.
• Instruct the patient, caregiver, and family on how to monitor peak flow.
• Instruct the patient to comply with therapy and the action plan for the best outcomes.

Nursing Documentation Guidelines

The nurse should document the following data:

• Breath sounds and secretions made, if any.
• The cough character and sputum, including color.
• Record vital signs.
• The care plan and those involved in planning.
• The patient and caregiver teaching plan.
• The patient’s response to administered medication.
• The progress towards the desired goals.
• Modifications to the care plan.

Also Read: Asthma Nursing Care Management