Bronchial asthma

Asthma is a disorder in which the trachea and bronchi respond more strongly to numerous stimuli, resulting in abrupt, recurring spells of trouble breathing, wheezing, and coughing. It occurs from a combination of genetic and environmental factors.

Epidemiology:

• It is one of the most common chronic lungs disease found in children are affected.
• Approximately 4 to 20 % of school-going children are affected.
• Peak incidence is found between 5-10 years of age.
• Boys are more sufferer than girls before puberty.
• More common among children living in inner cities, low-income populations, and minorities.

Classifications:

1. Allergic or extrinsic asthma:
   By a hyperimmune(IgE) response to the inhalation of specific allergens. Children with extrinsic asthma usually have a positive skin test for the offending allergen and have a positive family history of allergy.
2. Nonallergic or intrinsic type:
   produce in response to unidentified or non-specific factors (triggers) of the environment.
3. Mixed type:
   Cannot be specifically identified as extrinsic or intrinsic type.

Causes:

• Allergies: Allergens like animal dander, dust pollens, mites in house dust, smoke, fungi molds, tree, grain, fumes, chemicals, etc.
• Positive family history of asthma
• Respiratory infection
• Sensitization with a viral infection, exercise, emotional factors, and humidity during childhood.
• Excessive exhaustion, fatigue, emotional disturbances
• Low birth weight, age smoking, lack of medical care, young mother.

Clinical manifestation:

• A recurrent cough with or without wheezing.
• A nonproductive cough in an early phase gradually becomes episodic and persistent.
• spasmodic nocturnal coughing.
• Classical triad (a cough, wheeze, breathlessness)
• Rapid breathing
• Nasal flaring
• Chest pain
• Itching
• Polyuria
• Mental excitement
• Nasal congestion
• Sneezing
• Upper respiratory tract infection.
• Tachycardia
• Fever
• Cyanosis and pallor
• Difficulty in speaking
• Abdominal pain
• Sweating
• Looks fatigued
• Hyper-resonant, barrel chest
• Clubbing of finger

Diagnosis:

• Clinical presentations.
• History taking
• Physical examination
• Pulmonary function test and spirometry.
• Chest X-ray
• Blood investigations
• Sputum test
• Allergy test

Treatment:

1. Bronchodilators:
   Rapid-acting and long-acting drugs through nebulization, metered dose inhalation pressurized metered dose inhalation using a spacer device. Drugs are Aminophylline, terbutaline, salbutamol and formoterol. Nebulization in children: 0.5ml to 1ml asthalin plus 4ml of sterile water or normal saline through an aerosol mask.
    
2. Oxygen therapy
   Initiate intravenous therapy and send investigation as per prescription.
    
3. Administration of corticosteroid that is beclomethasone via metered-dose aerosol or powder inhaler for preventive therapy.
    
4. Other drugs:
   mast cell inhibitors i.e cromdyn, Anticholinergics: atropine derivatives such as ipratropium bromide.
    
5. Additional measures:

• Mild tranquilizers to remove anxiety and emotional stress
• Expectorants
• Antibiotics
• Comfortable position
• Chest physiotherapy after stabilization of acute attack
• Maintaining regular follow up, monitoring their symptoms, and avoiding known allergens
• Use preventive measures to minimize occupational hazards.

Nursing consideration:

Assessment:

• Assess the rate, and rhythm of respiration
• Abnormal sound
• Signs and symptoms and their severity
• Use of accessory muscles and hydration status, cyanosis, cerebral function, etc.

Nursing interventions:

1. Position the child in high fowler’s or sitting leaning forward
2. Use a calm, reassuring approach, explaining, procedures to the child and parents.
3. Administer drugs as prescribed.
4. Monitor vital signs every 1-2 hours as needed.
5. Monitor respiratory status including abnormal breath sounds and other signs such as fever, nausea, etc.
6. Administer oxygen if needed.
7. Maintain intake and output charts strictly.
8. Maintain serum electrolyte and blood gas values periodically
9. Provide a cold, moist environment.
10. Teach breathing exercises once airways began to open satisfactorily.
11. Administer mild sedatives for relieving anxiety.
12. Reassure the parents and child:
    • Encourage anxious parents to verbalize their feeling.
    • Review the coping behaviors of parents and encourage adaptive coping to manage anxiety.
    • Should not leave a child alone.
    • Inform the parents about the child’s condition and therapies adapted for the betterment of the child's health condition.
    • Encourage the parent’s involvement in the child’s care.

• A parent should be educated:
  • Avoid exposing the child to allergens.
  • Avoid foods that are known to provoke symptoms.
  • About allergic tests.
  • Importance of a calm and quiet environment.
  • Signs and symptoms of attacks.
  • Proper administration of drugs, their side effects and should not discontinue without consecration with a physician.
  • Demonstrate correct use of the inhaler and ask for a return demonstration.
  • Proper use and side effects of prophylactic drugs and danger of overuse.
  • Avoid parental rejection or overprotection of the child.
  • Encourage exercise and play
  • Follow-up visit.
  • Nutritional care: warm liquid diet, small amount frequently, continue breastfeeding if applicable.
  • Maintenance of hygienic measures.