MEDICAL PATHOLOGIES OF RESPIRATORY SYSTEM

ASTHMA

The function of the respiratory system is to supply body cells and tissues with oxygen

and eliminate carbon dioxide (CO2). Damage and disease in the respiratory system

greatly affect a person’s normal health function. It is a must to maintain the normal

and clear respiration, the maintenance of normal respiration and tissue oxygen

supply requires the well-functioning of airway flow. Some medical condition such as

asthma among others alter the proper respiratory pattern thus disturb an individual

wellbeing

Asthma is a chronic inflammatory disorder of the airway that causes recurrent

spasmodic episodes due to increased hyperirritability or responsiveness of the

bronchial tree to the various stimuli. It is a deterioration of the baseline asthma

control leading to acute wheeze, shortness of breath and dyspnoea. Asthma is

usually a reversible obstructive disease of the lower airway.

Causes and risk factors of asthma

The asthma is chronic disease characterized by the various associated risk factors:

• Upper respiratory tract infections (viral, etc)

• Exposure to triggers (occupational exposure: working in industry, smoking,

air, pollution, cold, dust, etc)

• Stress

• Family history

• Obesity

Pathophysiology overview of Asthma

The primary pathophysiologic process in asthma is persistent inflammation of the

airways which results in bronchoconstriction, airway hyper responsiveness (hyper

reactivity) and edema of the airways. The following is brief pathophysiological

process of asthma development.

The clinical manifestations of asthma/ Signs and symptoms of asthma

The asthma symptoms are associated with shortness of breath, wheezing, mucous

secretions, cough, chest tightness, quiet chest and decreased oxygen saturation.

The clinical manifestations of asthma/ Signs and symptoms of asthma

The asthma symptoms are associated with shortness of breath, wheezing, mucous

secretions, cough, chest tightness, quiet chest and decreased oxygen saturation.

 

The clinical manifestations of asthma/ Signs and symptoms of asthma

The asthma symptoms are associated with shortness of breath, wheezing, mucous

secretions, cough, chest tightness, quiet chest and decreased oxygen saturation.

Clinical manifestations of Asthma

Investigations

The following medical investigations that are most used in diagnosis of asthma

include Laboratory (Full blood account (FBC), Allergy test (Immunoglobulin E);

Spirometry; and Imagery (chest x- ray).

 

Treatment plan for asthma

Below is the diagram which summarizes the algorithm of asthma management .

The goals of asthma therapy are to reduce symptoms, improve lung function, and

minimize impairment of normal activity and sleep.

Properly using asthma medication, as prescribed by the doctor, is the basis of

good asthma control, in addition to avoiding triggers and monitoring daily asthma

symptoms.

The three main types of bronchodilator medicines

These are Beta 2-agonists (short- and long-acting forms), xanthine derivatives

and anticholinergics.

A. Beta 2 agonists

i) Short-acting beta 2-agonists (also called SABAs)

In inhaled forms, these medications include: Albuterol (Proventil® HFA, Ventolin®)

Short-acting beta 2-agonists (SABAs) are called “reliever” or “rescue” medicines

because they stop asthma symptoms very quickly by opening the airways. They

work within 15 to 20 minutes and last four to six hours. They are also the medicines

to use 15 to 20 minutes before exercise to prevent exercise-induced asthma

symptoms. Asthma medications can be taken by inhaling the medications (using

a metered dose inhaler, dry powder inhaler, or asthma nebulizer) or by swallowing

oral medications (pills or liquids).

ii) Long-acting beta-2 agonists (also called LABAs):

These medications include: Salmeterol (Serevent®) and Formoterol (Foradil®).

They are used twice a day to maintain open airways for long-term control, and they

must be used with an inhaled corticosteroid for the treatment of asthma. Long-

acting beta-agonists are not intended to be used alone for the treatment of asthma.

They are always used along with an inhaled corticosteroid. These medicines relax

the tightened muscles in the airways for a long time, up to 12 hours, and can help

control symptoms at night or during exercise.

Side effects include: Nausea and/or vomiting, Diarrhea and/or stomach ache,

Headache, Rapid or irregular heartbeat, Muscle cramps, Jittery or nervous feeling,

hyperactivity.

B. Xanthine derivatives

Xanthine derivatives are a group of alkaloids that work as mild stimulants and

bronchodilators. Xanthine derivatives ease symptoms of bronchospasm and make

breathing easier by relaxing the smooth muscles of the respiratory tract and reducing

the airway’s hypersensitive response to stimuli. Theophylline and aminophylline are

examples of xanthine derivatives and can be used to treat difficult-to-control or

severe asthma and must be taken daily.

C. Anti-cholinergic bronchodilator drugs

Anticholinergic bronchodilators are the type of medication used to treat respiratory

conditions such as asthma and chronic obstructive pulmonary diseases.

Ipratropium bromide (Atrovent® HFA) is an example of anticholinergic bronchodilator

drugs.

These are not quick-relief medications, but they can add to the bronchodilator effect

for certain asthmatics with difficult-to-control symptoms.

Medical Pathology, Student Book, Senior 58
Further considerations of asthma management
• Monitor vital signs (temperature, respiratory rate, pulse, blood pressure,SP02)
• Conduct basic health assessment
• Decision making (identify disturbed patient needs)
• Ensure the client safety and quality patient care
• Collaborate with health care team (Registered Nurse (RN), Physician)
• Implement medical prescription (administration of bronchodilators and
corticosteroids, antibiotics if signs of infection, oxygen therapy if desaturating).
• Keep confidentiality of patient
• Demonstrate ethical and moral values principles while nursing care delivery
• Demonstrate effective communication skills with patient, family members and
multidisciplinary team.
Evolution and complications of asthma
Although asthma is a chronic disease with no cure, most people with mild to
moderate signs and symptoms, asthma can improve with time or go into remission
for long periods. Without treatment of asthma, the improvement can occur. Some
complications related to asthma are:
• Respiratory Infections (E.g: Pneumonia)
• Sleeping disturbance
• Frequent hospitalisation
• Chronic airway inflammation/Chronic obstructive pulmonary disease
• Respiratory failure and death.
• Mental health issues (e.g: depression)