CASE StUDY

On

Bronchial Asthma

INTRODUCTION

I. Definition

Bronchial Asthma

Is a chronic disease of the respiratory system in which the airway occasionally constricts, becomes inflamed and is lined with excessive amounts of mucus, often in response to one or more triggers.

Bronchial asthma, an inflammation of the airways is the more correct name for the common form of asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate condition that develops when fluid builds up in the lungs as a complication of heart failure.

An acute exacerbation of asthma is referred to as an asthma attack. The clinical hallmarks of an attack are shortness of breath (dyspnea) and either wheezing or stridor.

In an asthma attack, the air passages of the lungs, known as bronchi, overreact to substances that are ordinarily harmless. Cells in the airways known as mast cells release histamines and leukotrienes, which induce inflammation. These substances prompt the smooth muscles of the airways to go into spasm and constrict. Soon, the bronchi become inflamed and release mucus, which further blocks the passage of air. Narrowing of the air passages is known as bronchoconstriction. When the airways are reduced in diameter, more effort is required to move air into and out of the lungs, and breathing becomes difficult.

Asthma can be classified into 3 types according to causative factors:• Atopic or Extrinsic asthma is due to inhaled allergens• Intrinsic asthma is usually secondary to chronic or recurrent infections of the bronchi,

sinuses, or tonsils and adenoids. There is evidence that this type develops from a hypersensitivity to the bacteria or, more commonly, viruses causing the infection. Attacks can be precipitated by infections, emotional factors, and exposure to nonspecific irritants.

• The third type of asthma, mixed, is due to a combination of extrinsic and intrinsic factors.

II. CausesAsthma attacks are caused by airway hyperresponsiveness—that is, an overreaction of the bronchi and bronchioles to various environmental and physiological stimuli, known as triggers. The most common causes of asthma attacks are extremely small and lightweight particles transported through the air and inhaled into the lungs. When they enter the airways, these particles, known as environmental triggers, cause an inflammatory response in the airway walls, resulting in an asthma attack.

Allergenic air pollution, from nature, typically inhaled, which include waste from common household pests, such as the house dust mite and cockroach, grass pollen, mould spores, and pet epithelial cells;

Indoor Allergenic air pollution from Volatile organic compounds, including perfumes and perfumed products. Examples include soap, dishwashing liquid, laundry detergent, fabric softener, paper tissues, paper towels, toilet paper, shampoo, hairspray, hair gel, cosmetics, facial cream, sun cream, deodorant, cologne, shaving cream, aftershave lotion, air freshener and candles, and products such as oil-based paint.

Medications, including aspirin, β-adrenergic antagonists (beta blockers), and penicillin. Use of fossil fuel related allergenic air pollution, such as ozone, smog, summer smog, nitrogen

dioxide, and sulfur dioxide, which is thought to be one of the major reasons for the high prevalence of asthma in urban areas;

Various industrial compounds and other chemicals, notably sulfites; chlorinated swimming pools generate chloramines—monochloramine (NH2Cl), dichloramine (NHCl2) and trichloramine (NCl3)—in the air around them, which are known to induce asthma.

Early childhood infections, especially viral respiratory infections. However, persons of any age can have asthma triggered by colds and other respiratory infections even though their normal stimuli might be from another category (e.g. pollen) and absent at the time of infection.

Exercise Allergenic indoor air pollution from newsprint & other literature such as, junk mail leaflets &

glossy magazines (in some countries). Emotional stress

III. Risk Factors

Gender Childhood asthma occurs more frequently in boys than in girls. It's unknown why this occurs although some experts find a young male's airway size is smaller when compared to the female's airway, which may contribute to increased risk of wheezing after a cold or other viral infection. Around age 20, the ratio of asthma between men and women is the same. At age 40, more females than males have adult asthma.

Family History of Asthma- Inherited genetic makeup predisposes you to having asthma. Frequent respiratory infections- increased production of IgE Premature birth- immature respiratory systemInfants exposed through maternal smoking- affects development of the fetusLow socio-economic environment- exposed to irritants

IV. Clinical Manifestations Dyspnea Wheezing Coughing Shortness of breath Tachypnea Tachycardia Over inflation of the chest (barrel chest) Cyanosis (severe attacks) Chest pain Loss of consciousness

V. Complications Respiratory failure Pneumothorax Lung infection Chronic obstructive pulmonary disease (COPD) Atelectasis

VI. Diagnostic Tests

1. Chest X-ray A chest x ray is a painless, noninvasive test that creates pictures of the structures inside your

chest, such as your heart, lungs, and bones. A chest x-ray may show mucous buildup and inflammation in the bronchioles indicating

bronchial asthma.

Nursing Responsibilities: Explain procedure to the client. Ask if client is pregnant. Make sure that client isn’t wearing any metallic objects. Instruct client to inspire deeply and hold breath.

2. History Taking and Physical Examination

It is important to obtain the past medical history of the patient whether he/she had been diagnosed or experiencing clinical manifestations of asthma before and what triggers it.

Performing physical examination is done to detect or confirm its symptoms.

Nursing Responsibilities: Establish rapport to patient. Ask pertinent questions only. Maintain nurse-patient relationship. Perform hand washing before and after Physical assessment Make sure hands and stethoscope are warm before placing to patients skin Perform physical assessment effectively. Document only what is important.

3. Lung function tests - for asthma include numerous procedures to diagnose lung problems. The two most common pulmonary function tests for asthma are spirometry and methacholine challenge tests.

Spirometry: This pulmonary function test for asthma is a simple breathing test that measures how much air you can blow out of your lungs and how quickly. It is often used to determine the amount of airway obstruction you have. Spirometry can be done before and after you inhale a short acting medication called a bronchodilator, such as albuterol. The bronchodilator causes your airways to expand, allowing for air to pass through freely. This test might also be done at future doctor visits to check your progress and to help your doctor determine if and how to adjust your treatment plan.

Methacholine challenge test: This lung function test for asthma is more commonly used in adults than in children. It might be performed if your symptoms and screening spirometry do not clearly or convincingly establish a diagnosis of asthma. Methacholine is an agent that, when inhaled, causes the airways to spasm (contract involuntarily) and narrow if asthma is present. During this test, you inhale increasing amounts of methacholine aerosol mist before and after spirometry. The methacholine test is considered positive, meaning asthma is present, if the lung function drops by at least 20%. A bronchodilator is always given at the end of the test to reverse the effects of the methacholine.

Using a spirometer, an instrument that measures the air taken into and exhaled from the lungs, the doctor will determine several values:

Vital capacity (VC), the maximum volume of air that can be inhaled or exhaled. Peak expiratory flow rate (PEFR), commonly called the peak flow rate, the maximum flow rate

that can be generated during a forced exhalation. Forced expiratory volume (FEV1), the maximum volume of air expired in one second.

If the airways are obstructed, these measurements will fall.

Nursing Responsibilities: Explain Procedure Instruct patient not to have a heavy meal before the test Instruct patient not to smoke 4-6 hours before the test Demonstrate the proper breathing technique

4. Nitric Oxide An exhaled nitric oxide test is one of several tests that can be used to check for asthma. It

involves breathing into a mouthpiece attached to a machine that measures the level of nitric oxide gas in your breath. Nitric oxide is produced by the body normally, but high levels in your breath can mean that your airways are inflamed — a sign of asthma.

More than 25 parts per billion in children and 35 parts per billion in adults may signal airway inflammation caused by asthma.

Nursing Responsibilities:

Explain procedure Instruct patient not to take alcohol 4-6 hours before the test

5. Sputum eosinophils This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus

(sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).

Nursing Responsibilities: Instruct patient to clear nose and throat and rinse mouth to decrease contamination of the

sputum. Instruct patient to cough out the sputum not spit. Make sure specimen is in a sterile container and deliver it to the lab within two hours.

Judging the Severity of Asthma

1. Mild intermittent asthma. Symptoms occur less than twice a week, rare exacerbation or asthma attacks and infrequent nighttime asthma symptoms. (There are also specific findings on lung function tests.)

2. Mild persistent asthma. Symptoms occur more than twice a week, but less than once a day, and asthma attacks that affect activity. These people do have nighttime symptoms of asthma more than twice a month. (There are also specific findings on lung function tests.)

3. Moderate persistent asthma. Symptoms occur daily, with nighttime symptoms more than once a week. These people tend to have asthma attacks that affect their activity that may last several days. In addition, these patients require daily use of their quick acting asthma medication to control symptoms. (There are also specific findings on lung function tests.)

4. Severe persistent asthma. Continual symptoms occur day and night, limited activity and frequent asthma attacks. (There are also specific findings on lung function tests).

VII. TreatmentMedical Management There are two general process of asthma medication: quick relief medication for immediate treatment of asthma symptoms and exacerbations and long acting medication to achieve and maintain control and persistent asthma. Because of underlying pathology of asthma is inflammation, control of persistent asthma is accomplish primarily with the regular use of anti-inflammatory medications.

•Quick relief medication Bronchodilators (Short acting beta adrenergic agonists and Anti-cholinergic)-are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They have the rapid onset of action. You take them when you are coughing, wheezing, having trouble breathing, or having an asthma attack. They are also called "rescue" drugs.

•Long-acting control Medication1. Corticosteroid -are the most potent and effective anti inflammatory currently available. They are broadly effective in alleviating symptoms, improving air way functions, and decreasing peak flow variability. These medications are contraindicated in acute asthma exacerbation. 2. Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night these agents are also effective in the prevention of exercise-induced asthma.3. Leukotriene Receptor Antagonists-Direct antagonist of mediators responsible for airway inflammation in asthma.- Used for prophylaxis of EIA and long-term treatment of asthma as alternative to low doses of inhaled corticosteroids.

4. Mast Cell Stabilizers- Prevent the release of mediators from mast cells that cause airway inflammation and bronchospasm.5. Combination Beta-Agonist/ Corticosteroid- Advair is a unique inhaled combination medication used frequently in the treatment of asthma.- It consists of a long-acting beta-agonist (salmeterol) and inhaled corticosteroid (fluticasone).

6. 5-Lipoxygenase Inhibitors - Inhibit the formation of leukotrienes. Leukotrienes activate receptors that may be responsible for events leading to the pathophysiology of asthma, including airway edema, smooth muscle constriction, and altered cellular activity associated with inflammatory reactions.

Nursing Responsibilities: Check doctor’s order Confirm right client Assess or ask if patient has any allergies to certain kinds of drugs Check if the patient manifests contraindications of the drug Calculate the right dosage of drug Explain the action of the drug Administer drug to the right route Observe patient if patient shows any allergies Instruct client to report any discomforts

NURSING MANAGEMENT:1. Assess respiratory status by closely evaluating breathing patterns and monitoring vital signs2. Administer prescribed medications, such as bronchodilators, anti-inflammatories, and antibiotics3. Promote adequate oxygenation and a normal breathing pattern4. Explain the possible use of hyposensitization therapy5. Help the child cope with poor self-esteem by encouraging him to ventilate feelings and concerns. Listen actively as the child speaks, focus on the child’s strengths, and help him to identify the positive and negative aspects of his situation.6. Discuss the need for periodic PFTs to evaluate and guide therapy and to monitor the course of the illness.7. Provide child and family teaching. Assist the child and family to name signs and symptoms of an acute attack and appropriate treatment measures8. Refer the family to appropriate community agencies for assistance.

VIII. PreventionPatient with recurrent asthma should undergo test to identify the substance that participate the symptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the key to quality asthma care.

PATIENT’S PROFILE

Name: Mrs. A.C

Age: 75 y/o

Gender: Female

Date of Birth: October 2, 1937

Status: Widow

Address: Balzain West. Tuguegarao City

Nationality: Filipino

Religion: Jehova’s Witness

Date of Admission: November 12, 2012

Time of Admission: 6:05 AM

Chief Complaint: Cough and dyspnea

Attending Physician: Dr. Zingapan

Admitting Diagnosis: Bronchial Asthma in Acute Exacerbation

Date of discharge: November 14, 2012

Time of discharge: 8:00 am

Source of information: Chart, patient, S.O.

NURSING HISTORY

Past HistoryAccording to the patient, she never had any of the vaccines when she was a child because

vaccines were not yet widely offered in the country that time. She experienced having mumps, chicken pox, and measles. She also added that she was often bitten by a dog, “maraming beses na, siguro mga apat o lima”. When further asked if what were the interventions done, she said that “hinuhugasan ko lang ng maigi gamit yung sabong panlaba, pagkatapos pinapahiran ko ng bawang”. When asked if she had any allergies on food and medication, none of these were mentioned but she verbalized that she experiences allergic symptoms when exposed to dust. She said that when she encounters sickness like headache and toothache, she just took a rest but if she can’t tolerate it anymore she takes OTC drugs. She added that whenever she experiences having cough her mother would let her drink her excreted urine in the morning. When further asked if how could this help her, she just answered by believing that it would relieved her cough. She added that she had a history of occasional smoking in her teenage years. She also acknowledged that she was 47 years old when she was diagnosed of having hypertension and 55 years old when first diagnosed of having asthma. She added that she copes with it by using her puff and nebulizer (Symbicort, Ventolin respectively).

History of Present IllnessAccording to the patient, 4 days prior to hospitalization, she experienced having cough and

difficulty of breathing (dyspnea), and she managed it by using her puff and nebulizer (Symbicort, Ventolin respectively). On the day prior to admission, the patient again experienced difficulty of breathing (dyspnea) which prompted her to seek immediate medical attention. She was then told that she will be needing confinement as said by the attending physician, Dr. Zinggapan at PGH. She then had an admitting diagnosis of Bronchial Asthma in Acute Exacerbation. The physician ordered for the administration of oxygen via nasal cannula to aid the patient in respiration and nebulization every 4 hours with CPT (Chestphysio Therapy) during and after nebulization to loosen and expel secretions. The physician prescribed cefuroxime 750mg, hydrocortisone 100mg and requested the patient to undergo Diagnostic Tests such as CBC (Complete Blood Count) with APC , Na,K, and Chest X-Ray.

Family History

FATHER MOTHER

( ) Cancer ( ) Cancer( /) Asthma ( ) Asthma( ) TB ( ) TB( ) DM ( ) DM( ) Heart Disease ( ) Heart Disease( ) Hypertension (/) Hypertension

Social HistoryAccording to the patient, she stays at home most of the time. Their family attends mass on

Sundays to worship. According to her, she has a good relationship with her family. And also manages to have a good relationship with her neighbors. Because of her age and condition (that is having bronchial asthma), her family let her do simple chores like folding clothes and sometimes washing the dishes . The patient finished her Elementary Education but wasn’t able to continue her H.S and College education due to financial constraints.

OB HistoryThe patient had her menarche at the age of 13 and usually consumes 2-3 pads per day and it

typically last for 4 days. She had her coitarche as soon as she got married at the age of 20. She then had an OB score of G5P5 (4105). She had her menopause at the age of 50.

Gordon’s 11 functional health pattern

FUNCTIONAL PATTERN

BEFORE HOSPITALIZATION DURING HOSPITALIZATION

Health Perception/Health

Management pattern

Patient AC perceives herself as a healthy individual who is able to do her chores and can take care of her family. She defines health as the absence of pain and disease and can do whatever she wishes to. Whenever she feels something is wrong with her health such as headache, common colds, fever, cough, and stomach ache. She manages it by taking OTC drugs like Paracetamol, Alaxan, Enervon C, and Mefenamic Acid. “Importante ang kalusugan kaya dapat nating pangalagaan” as verbalized by the patient.

She considers herself unhealthy due to her underlying condition. For her, she is a bit useless because she can’t do her daily routine of doing the chores, she easily gets tired. One more reason why she considers herself unhealthy is that she needs to take her medicines to regain her strength. “Hindi ko na masyadong nagagawa yung mga dati kong gawain dahil madali na akong mapagod. Mas kailangang pangalagaan ang kalusugan ko lalo na ngayong tumatanda na, mas madaling dapuan ng sakit”

Nutritional - Metabolic

Pattern

Client AC eats three times a day without any difficulty and takes her snack on the afternoon. She loves to eat vegetables and fish. She claims that she doesn’t have any food allergies. The patient drinks an average of 6- 8 glasses of water a day. She weighs 47 kg & has a height of 5’6. Her BMI 17.08 is.

Diet as tolerated prescribed by physician. “Hindi ako masyadong nakakakain. Wala akong gana. Wala din naman akong malasahan sa mga kinakain ko.” She drinks approximately 5-6 glasses of water a day. She weighs 46 kg and BMI of 16.31.

Elimination Pattern

Patient AC defecates twice a day, with a brownish color. She voids 4-5 times in a day. Urine is yellow in color and aromatic in smell, no pain felt when voiding and defecating.

Patient AT defecates twice a day, brownish in color, soft in consistency; she voids 2-4 times a day, yellowish in color, without pain.

Activity - Exercise Pattern

In the morning, she eats her breakfast at around 6; after her meal, she does her household chores such as watering the plants around their house and considers this as her exercise. At noon, after lunch, her leisure activities include watching television programs.

Patient AC ambulates inside the room assisted by her mother, she also does ROM exercises like arm flexion & extension. To ease boredom, she talks with other clients.

Sleep - Rest Pattern

The patient claims that she usually sleeps 8-9 hours a day with no difficulties in falling and staying asleep. He usually goes to bed around 9pm and wakes up at around 6:00am. She enjoys watching T.V. while resting. She usually takes 25 to

Patient AC sleeps at 10pm or 11 pm and wakes up early at 6am. Her sleep is usually being interrupted by routines like VS taking and medication administration and the noise of other patients.

30- minutes sleep in the afternoon. Cognitive – Perceptual

Pattern

She can speak and understand Tagalog, English, Ytawes and Ybanag. She has visual and hearing impairment as evidenced by use of eyeglasses and asking of repetitions of questions though she can understand, respond and follow instructions.

The patient doesn`t have any difficulty in expressing herself. She is oriented to time and place. She can speak dialects understood by others (Tagalog, English, Ytawes and Ybanag). There is no problem in visual and hearing, there is presence of decreased sense of taste.

Self-Perception – Self-Concept

Pattern

Client AT describes herself as loving and caring, humble and God fearing person. She has a positive outlook about life. She said that she is concerned about her family.

Despite having a health problem, she still believed that everything will be alright. She is more concerned right now about her recovery.

Role – Relationship

Pattern

Patient AC is a friendly and active person she loves to socialize with her neighbors. She has a great bond with her family—shares stories with them, spends most of free time with them. There is no conflict in their family that they cannot resolve.

Her admission caused changes in her role. She is cooperative and participative with the health care regimen. Her concern is that, she can’t take care of her family while she’s in the hospital; instead, they are the ones taking care of her.“Nakakahiya kasi dumagdag pa akong aalagaan nila”

Sexuality – Reproductive

Pattern

Patient AC had her menarche when she was 14 years old with duration of 3-5 days using 2 pads a day (soaked). She had her menopausal period when she was 50 years of age.

The patient still expresses her feminity by using appropriate clothes to her gender and through her actions.

Coping – Stress Tolerance

Pattern

Whenever she had a problem, she tells it to her family & friends. She said that by merely voicing out to them, she feels comfortable and is at ease. Handles life stresses through prayers and believes that everything will go well in the end.

Hospitalization is the most stressful experience for her. She finds relief and comfort through the support of her family and friends, and prayers.

Value – Belief Pattern

AC is a Jehovah’s witness and she goes to church every week with her family. She claims that she has a strong devotion and faith to Jehovah and that nothing is impossible as long as she believes.

She stated that she knows that God will always be at her side. AC always prays for her recovery and asks God to protect her family and to help her endure her suffering.

ANATOMY AND PHYSIOLOGY

RESPIRATORY SYSTEM

• Respiration is the process of taking in oxygen, producing energy with it, and excreting gaseous waste products.

• Basic functions of the respiratory system

• Supplies body with oxygen

• Disposes of carbon dioxide

• Four processes involved in respiration

• Pulmonary ventilation - exchange of gases between lungs and atmosphere

• External respiration( Pulmonary) - exchange of gases between alveoli and pulmonary capillaries

• Transport of respiratory gases - processes of gas exchange and various metabolic functions taking place in the lungs, generally at the alveolar level.

• Internal respiration (Tissue) - exchange of gases between systemic capillaries and tissue cells

Parts of the Upper Respiratory Tract

Nose & nasal cavity: The function of this part of the system is to warm, filter and moisten the incoming air.

Pharynx: Here the throat divides into the trachea (wind pipe) and esophagus (food pipe). There is also a small flap of cartilage called the epiglottis which prevents food from entering the trachea.

Larynx: This is also known as the voice box as it is where sound is generated. It also helps protect the trachea by producing a strong cough reflex if any solid objects pass the epiglottis.

Parts of the Lower Respiratory Tract

Trachea: Also known as the windpipe this is the tube which carries air from the throat into the lungs. The inner membrane of the trachea is covered in tiny hairs called cilia, which catch particles of dust which we can then remove through coughing. The trachea is surrounded by 15-20 C-shaped rings of cartilage at the front and side which help protect the trachea and keep it open. They are not complete circles due to the position of the esophagus immediately behind

the trachea and the need for the trachea to partially collapse to allow the expansion of the esophagus when swallowing large pieces of food.

Bronchi: The left bronchi is narrower, longer and more horizontal than the right. Irregular rings of cartilage surround the bronchi, whose walls also consist of smooth muscle. Once inside the lung the bronchi split several ways, forming tertiary bronchi.

Bronchioles: Tertiary bronchi continue to divide and become bronchioles, very narrow tubes, less than 1 millimeter in diameter. There is no cartilage within the bronchioles and they lead to alveolar sacs.

Alveoli: Individual hollow cavities contained within alveolar sacs (or ducts). Alveoli have very thin walls which permit the exchange of gases Oxygen and Carbon Dioxide. They are surrounded by a network of capillaries, into which the inspired gases pass. There are approximately 3 million alveoli within an average adult lung.

Diaphragm: The diaphragm is a broad band of muscle which sits underneath the lungs, attaching to the lower ribs, sternum and lumbar spine and forming the base of the thoracic cavity.

Breath Sounds

Breath sounds can be classified into two categories, either NORMAL or ABNORMAL (adventitious). Breath sounds originate in the large airways where air velocity and turbulence induce vibrations in the airway walls.

Normal Breath Sounds

Bronchial Sounds

Bronchial breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx.

Bronchovesicular Sounds

Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase. Sounds intermediate between bronchial and vesicular breath sounds; it is normally heard between the 1st and 2nd intercostal spaces anteriorly and posteriorly between scapulae.

Vesicular Sounds

Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung field.

Abnormal Breath Sounds

Crackles

Crackles are discontinuous, explosive, "popping" sounds that originate within the airways. They are heard when an obstructed airway suddenly opens and the pressures on either side of the obstruction suddenly equilibrates resulting in transient, distinct vibrations in the airway wall. The dynamic airway obstruction can be caused by either accumulation of secretions within the airway lumen or by airway collapse caused by pressure from inflammation or edema in surrounding pulmonary tissue.

Wheezes

Wheezes are continuous musical tones that are most commonly heard at end inspiration or early expiration. They result as a collapsed airway lumen gradually opens during inspiration or gradually closes during expiration. Wheezes may be monophonic (a single pitch and tonal quality heard over an isolated area) polyphonic (multiple pitches and tones heard over a variable area of the lung).

Rhonchi

Ronchi (Low pitched wheezes) are continuous, both inspiratory and expiratory, low pitched adventitious lung sounds that are similar to wheezes. They often have a snoring, gurgling or rattle-like quality.

Stridor

Stridor are intense continuous monophonic wheezes heard loudest over extrathoracic airways. They tend to be accentuated during inspiration when extrathoracic airways collapse due to lower internal lumen pressure.

Stertor A heavy snoring inspiratory sound occurring in coma or deep sleep, sometimes due to

obstruction of the larynx or upper airways.

IMMUNE SYSTEM

The immune system protects the body from possibly harmful substances by recognizing and responding to antigens.

Antigens are substances (usually proteins) on the surface of cells, viruses, fungi, or bacteria. Nonliving substances such as toxins, chemicals, drugs, and foreign particles (such as a splinter) can also be antigens.

The immune system recognizes and destroys substances that contain antigens.

Immune Response

The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful.

Innate Immunity

Innate, or nonspecific, immunity is the defense system with which you were born. It protects you against all antigens. Innate immunity involves barriers that keep harmful materials from entering your body. These barriers form the first line of defense in the immune response.

Cough reflex Enzymes in tears and skin oils Mucus, which traps bacteria and small particles Skin Stomach acid

Acquired Immunity

Acquired immunity is immunity that develops with exposure to various antigens. Your immune system builds a defense against that specific antigen.

Passive Immunity

Passive immunity is due to antibodies that are produced in a body other than your own. Infants have passive immunity because they are born with antibodies that are transferred through the placenta from their mother. These antibodies disappear between ages 6 and 12 months.

Immune System Cells and their Primary FunctionsNeutrophil Phagocytosis and inflammation; usually the

first cell to leave the blood and enter infected tissues.

Monocyte Leaves the blood and enters the tissues to become a macrophage.

Macrophage Most effective phagocyte; important in later stages of infection and tissue repair; located throughout the body to “intercept” foreign substances.

Basophil Motile cell that leaves the blood, enters tissues, and releases chemicals that promote inflammation.

Mast cell Nonmotile cell in connective tissues that promotes inflammation through the release of chemicals.

Eosinophil Enters tissues from the blood and release chemicals that inhibit inflammation.

Natural killer cell Lyses tumor and virus- infected cells.

Chemical Mediators

Histamine –an amine released from mast cells, basophils and platelets; causes vasodilation and increases vascular permeability.

Kinins –polypeptides derived from plasma proteins; causes vasodialtion, increase vascular permeability, stimulate pain receptors and attract neutrophils.

Interferons –are proteins produced by most cells, thet interfere with virus production and infection.

Complement –a group of plasma proteins that stimulate the release of histamine, activate kinins, lyse cells and promote phagocytosis.

Prostaglandins –a group of lipids, some of which cause smooth muscle relaxation and vasodilation. It stimulates pain receptors.

Leukotrienes –a group of lipids, produced primarily by mast cells and basophils, that cause prolonged smooth muscle contraction (especially in the lung bronchioles).

Blood Components

The immune system includes certain types of white blood cells. It also includes chemicals and proteins in the blood, such as antibodies, complement proteins, and interferon.

B lymphocytes become cells that produce antibodies. Antibodies attach to a specific antigen and make it easier for the immune cells to destroy the antigen.

T lymphocytes attack antigens directly and help control the immune response. They also release chemicals, known as cytokines, which control the entire immune response

Antibody

- any of a large variety of proteins normally present in the body or produced in response to an antigen which it neutralizes, thus producing an immune response.

Classes of Antibodies and Their Functions

Antibody Total Serum Antibody (%) DescriptionIgG 80-85 It can cross the placenta and

provide immune protection to the fetus and newborns.

IgM 5-10 It is responsible for transfusion reactions in the ABO blood system.

IgA 15 Secreted into saliva, into tears, and onto mucous membranes to provide protection on body surfaces; found in colostrums and milk to provide immune protection to newborns.

IgE 0.002 Binds to mast cells and basophils and stimulates the inflammatory response.

IgD 0.2 Functions as antigen binding receptor on B cells.

PATHOPHYSIOLOGY OF BRONCHIAL ASTHMA

Predisposing Factors Precipitating Factors

-age -exposure to allergens and pollutants

-gender -obesity

-race -viral respiratory infections

-history of allergies -Beta blockers medications

-family history -Psychological stress

-weather -Hygiene

-Antibiotic use

-Socioeconomic factor

-GERD

-Exercise

-Emotional expression

Stimulation of B lymphocytes

Production of IgE

Attachment of IgE to mast cells and basophils

A

A

Release of chemical mediators

Inflammation cAMP

Imbalanced stimulation of beta and alpha adrenergic receptors

mucous production Capillary dilation bronchospasm

Edema of the airway stimulation of alpha receptor of Beta receptors

Bronchoconstriction bronchodilation

DOB/SOB and chest tightness Cough Wheezing Hyperventilation

nasal flaring Pursed lip breathing Loss of Carbon Dioxide

Increased respiratory work demand Tachycardia Uneven Lung aeration Elevated Blood pH

Labored breaths/ Use of accessory muscle Tachypnea Incomplete emptying of alveoli Respiratory Alkalosis

hypoventilation

Compensating mechanism failed Fatigue Hyperinflation of alveoli

Respiratory failure hypoventilation poor fluid and food intake

Impaired gas exchange CO2 retention anorexia increased fatigue breakdown of fats

B C

D

E

Hypoxemia Respiratory Acidosis Hypercapnea Hypoxemia Barrel chest Production of fats

Hypoxia Hyperventilation Ketone formation

Cellular Ischemia Lactic Acid production Metabolic acidosis

Tissue necrosis metabolic acidosis

Vital Organ Failure death Hypoventilation Headache Mental dullness Kussmaul’s breathing Hyperkalemia

Death

B C ED