It is May 1st 2018 and it’s World Asthma day.
If you have asthma do endeavour to carry your inhaler regardless of the last time you had an attack. Some people say that the attack feels like one being strangulated or suffocated.
What is Asthma
National Institutes of Health (2014) defined asthma as a chronic lung disease which causes the inflammation and narrowing of the airways and presents with recurrent episodes of wheezing sound, chest tightness and coughing (mainly at night and early in the morning).
A popular definition by Global Initiative for Asthma (GINA, 2016) states that “Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation”.
There are different definitions of asthma which incorporate other subtle signs and symptoms, therefore it is important that nurses and other health professionals are proficient in their knowledge of asthma and its management.
Pathophysiology
Asthma is marked by characteristic episodes of symptoms and variable obstruction of the airway which can occur spontaneously or triggered by environmental factors. Exposure to allergens or viruses causes increased inflammation and exacerbation of symptoms such as cough, wheezing, chest tightness and dyspnoea (difficulty in breathing).
The main characteristic of asthma is inflammation of the bronchi and bronchioles which is marked by the release of various cells and chemical mediators which consequently leads to bronchoconstriction, airway oedema, airway hyperresponsiveness and airway remodelling. Airway remodelling leads to hyperplasia of submucosal and goblet cells and cause hypersecretion of mucus. Mucus plugging of the alveoli is a key cause of asthma death.
Majority of deaths from acute asthma takes place outside the hospital. Asthma patients whose symptoms did not improve either at the emergency department or in the ward should be admitted to intensive care unit.
Therefore, it is paramount that the asthmatics are equipped with the necessary knowledge and support to enable them to manage themselves.
Assessment
British Thoracic Society /Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016) recommends spirometry as the chosen method of assessment to be carried out initially to ascertain the extent of airway obstruction.
Some patients are known to have triggers such as viral infections and cold air.
Diagnosis
A well detailed history taking and good knowledge of differential diagnosis will ensure that asthma is diagnosed appropriately.
In the view of BTS/SIGN (2016), asthma diagnosis is based on the identification of the characteristic pattern of signs and symptoms and the lack of a different explanation for them.
Once asthma is diagnosed, the physician assesses the patient for the level of severity. The presence of intense symptoms indicates an asthma attack.
Management
The significance of treating asthma symptoms once they are detected cannot be overemphasized as it prevents the symptoms from worsening.
Pharmacological management of Asthma:
Inflammation of the airways is central to the pathogenesis of asthma, hence systemic corticosteroid forms part of the first-line treatments for acute asthma.
Intravenous hydrocortisone 200mcg and Prednisone 4g should be given in accordance with BTS/SIGN (2016) guidelines. Other sources advocates the usage of oral and intravenous steroids in the management of severe asthma.
Ipratropium nebulizer 500mcg to be given every 20 minutes for 1 hr and later reduced to Qds. It is a bronchodilator that eases breathing by relaxing the air passages.
Salbutamol nebulizer 5mg Qds. β2-adrenergic agonists are the first-line treatment for smooth-muscle mediated bronchoconstriction and are most reliable for dilating the bronchioles (GINA, 2016).
Iv Magnesium sulphate 2g in cases of hypomagnesia. Studies showed that the administration of 2g of Magnesium sulphate increases the dilation of the bronchioles in patients with severe asthma regardless of normal magnesium levels.
Health education is vital in the management of Asthma as it ensure asthmatics are able to self-manage, monitor symptoms, adhere to written asthma care plan and attend review appointments as recommended by GINA (2016) to avoid hospital admissions.
The BTS/SIGN (2016) reported evidence in which self-management was considered to reduce emergency use of healthcare resources and improve markers of asthma control.
Ideally, there is an asthma care plan for all sufferers which should adhered to. Asthma UK (2016) stressed on the importance of patients adhering to their written asthma care and added that asthma patients are four times less likely to present in the hospital if they utilize their asthma care plan.
Conclusion
It is paramount that asthma patients are supported by healthcare professionals to make sure they confidently self-managed, experience lesser symptom and thus, require less hospital visits.
P.S.
I am a registered volunteer of Asthma UK. Detailed information about asthma, its management and events are on the website.
This post is adapted from an Asthma case study, to access the full study do not hesitate to contact me.
Thanks for reading. Have a great May.
