Asthma: Care of a Patient with Asthma

Specific signs and symptoms of Asthma and Appropriate Interventions.

1. As soon as you receive a patient with asthma place him in a comfortable sitting position and do his vital signs including oxygen saturation
2. Arterial oxygen saturation (SaO2) may be reduced. This can be corrected by administering oxygen. It is recommended that oxygen therapy be commenced if SaO2 isless than92%.
3. Heart rate is generally elevated as a response to the reduced SaO2 saturation and pneumonia. Bronchodilators and anxiety also play a role in increasing heart rate. The anxiety will decrease as the patient's condition improves.
4. Expiratory Wheeze: Will generally decrease following the administration of a bronchodilator and an anti-inflammatory medication such as pulmicort. The method of bronchodilator administration should be considered carefully. Spacers are generally more efficient than nebulisers.
5. Decreased Peak Flow: In an acute severe attack the patients peak flow may decrease by as much as 50%. When peak flow is low Puffers / inhalers are of limited value because the patient is unable to inhale the medication therefore spacers should be used. Spacers come in adult and pediatric sizes. These have been shown to improve efficiency of delivered doses by 60%.
6. Asymmetry of lung expansion may occur due to plugging with plug(s) of mucus or presence of pneumothorax. Underwater Seal Drain may need to be inserted or a bronchoscopy performed to remove plugs of mucus. This is a medical procedure and must be done by an appropriate qualified doctor.
7. Anxiety is a frequent occurrence during mild and severe asthma. Staying with the patient, helping him maintain an upright posture and oxygen administration will be helpful.
8. Make the patient comfortable by placing him in a position which is comfortable to him. You can read more about nursing positions here: Patient Positions for Nurses.
9. Saline nebuliser: Can be used to help patients loosen secretions which may be difficult to expectorate due to dehydration

Commonly used Medications:

1. Oxygen usage; Use oxygen if oxygen saturation is less than 92. This would generally be indicated in the severe and critically ill asthmatics.
2. Inhaled Beta agonist (salbutamol). Dosage is given according to severity. Generally 6 to 12 puffs are given and then the patient is assessed.
3. Ipratropium: Generally used only in severe and critical asthma. 2 to 4 puffs are given and then the patient is reassessed. Up to three doses of 250mcg may be given in first hour.
4. Corticosteroids: Used in all except the mildest form of asthma. Oral prednisolone may be used. Standard dose is 1mg/kg/dose given at six hourly intervals.
5. I.V. Salbutamol: Indicated only in critical asthmatics if there is poor response to nebulised therapy.
6. Aminophylline: Is used only in critical asthmatics who do not respond to IV salbutamol. Only used in the Intensive Care Unit in some hospitals.
7. Intubation and Ventilation; Only in critical stages when it is necessary to save the life of the patient. In some instances it may be necessary to paralyse the patient to relieve the bronchospasm. This is done only in the Intensive Care unit.

Current data suggests that asthma severity is determined early in life and that disease progression may not occur outside early childhood. Furthermore, no therapy has been demonstrated to clearly prevent or reverse structural airway changes in patients with persistent asthma. Thus, the primary goal of asthma therapy is to prevent disease exacerbations rather than to halt disease progress, at least in patients past early childhood. Published reports of severe exacerbations in patients with reported mild asthma may actually reflect inclusion of patients with more severe forms of the disease who were inappropriately classified in terms of asthma severity.

Asthma is generally due to an allergy/sensitivity to foreign matter. The offending substances are either eaten in foods or breathed in from the environment via the air passages. These irritants act in a complex manner and cause bronchospasm. Some common allergens which cause asthma in human beings include bedroom dust, cat dander, and house dust mite. Hypersensitivity to Cockroach allergens has also been linked to asthma attacks. This study actually showed that 36.8 % of the sampled children were allergic to cockroach allergen.

Discharge planning should begin at time of admission because this will allow the patient to be seen by the nurse educator, physiotherapist, allergist and other health care professionals. Proper discharge planning associated with patient education has been shown to result reduced six monthly admissions and reduced remissions of asthma attacks. Early treatment and discharge accompanied by a return to normal health reduces the probability of formation of chronic obstructive airway disease.