Asthma (Reactive Airway Disease)

• Definition: An obstructive disease of the airways caused by increased responsiveness of the tracheobronchial tree to various stimuli such as allergens, infection, exercise, cold air, or stress.
• Pathophysiology: Airway stimuli result in spasms and edema of the bronchi and bronchioles. There is increased production and viscosity of mucus, and air is trapped distal to the resultant obstruction. There is impaired gas exchange in the alveoli.
• Etiology: There is familial predisposition to asthma. Stimuli that may precipitate exacerbations (attacks) include any substance to which the person is allergic, viruses, smoke, dust, cold air, or exercise.
• Manifestations: Wheezing, dyspnea, uncontrollable cough, nasal flaring, musical rales, and anxiety.
• Med Tx: Prevention of attacks through identification and avoidance of provoking stimuli and with administration of corticosteroids, salmeterol, and cromolyn sodium. Treatment of attacks with bronchodilators (such as albuterol or aminophylline), epinephrine, corticosteroids, expectorants, and antibiotics (if infection is present).
• Nsg Dx: Ineffective airway clearance, impaired gas exchange, activity intolerance, anxiety.
• Nsg Care: Monitor ongoing respiratory status. Monitor for side effects of medications. Encourage fluids. Plan care to allow for periods of uninterrupted rest. Educate regarding avoidance of and treatments of attacks. Support.
• Prognosis: About half will outgrow exacerbations. If asthma persists into the teen years, it will likely continue into adulthood. Persistent asthma may lead to the development of chronic obstructive lung disease.