Asthma

Ikeu Nurhidayah,
M.Kep., Sp.Kep.An
 Introduction

Chronic inflammatory disease of the airways

Most common childhood chronic disease
Affects ~4.8 million (CDC, 1995)
>100 million days of restricted activity
470,000 hospitalizations/year
How many children are affected by
asthma?
1 in 10 children have asthma

Increasing over last 2 decades.

With the correct preventative treatment and support

from schools, family and the wider community,
children with asthma should be able to lead a full
and active lifestyle.
 Introduction

>5000 deaths annually

Highest in blacks ages 15-24
Hospitalizations highest in blacks & children
Why is asthma a significant problem

Approximately 1500 individuals die per year from

asthma of these, 85% die for the following reasons;
Severity of attack not recognised by the individual
with asthma, the career, or the doctor/nurses.
Inadequate treatment, or inappropriate treatment
Delays in treatment
What is asthma?
Inflammation in the bronchioles causes increased
airway sensitivity daily preventer asthma treatment
controls the inflammation and reduces sensitivity.
If the child is not well controlled, a small exposure to
a trigger factor may induce symptoms. Muscles lining
the bronchioles tighten causing chest-
tightness,wheeze,breathlessness or cough.
It is for these symptoms the child will need their
reliever (blue) inhaler.
 Working definition of asthma (1995, NHLBI)
Asthma is a chronic inflammatory disorder of
the airways in which many cells & cellular
elements play a role (mast cells, eosinophils, T
lymphocytes, macrophages, neutrophils, &
epithelial cells).
 In susceptible individuals, inflammation causes
recurrent episodes of wheezing, breathlessness,
chest tightness, and coughing, particularly at
night/early morning. These episodes are
associated with variable airflow obstruction often
reversible spontaneously/treatment
KLASIFIKASI :
a. ASTHMA INTRINSIK (NON ALERGI)
GANGGUAN S.S.PARASIMPATIS
HIPERAKTIFITAS SARAF KOLINERGIC
GANGGUAN S.S. SIMPATIS
BLOKADE RESEPTOR ADRENERGIC DAN
HIPERAKTIF RESEPTOR ADRENERGIC
BRONKHUS MENYEMPIT
b. ASTHMA EKSTRINSIK (ALERGI)
ALERGEN MASUK KE SAL. NAFAS
MERANGSANG SISTEM IMMUN
MEMBENTUK Ig E PADA PERMUKAAN
MASTOSIT PADA SAL. NAFAS IKATAN
ALERGEN DG Ig E PELEPASAN MEDIATOR
KIMIA :
- HISTAMIN
- LEUKOTRIEN
- PROSTAGLANDIN
- EOSINOPHIL CHEMOTAXIC OF
ANAPHYLACTIC
Etiologi Asma

Penyebab asma, masih belum jelas sampai saat ini.

Diduga faktor yang memegang peranan utama adalah
reaksi hipersesitivitas dari trakea dan bronkus. Hiper-
reaktivitas bronkus masih belum diketahui penyebab,
diduga karena adanya hambatan sistem adrenergik
parsial, kurangnya enzim adenilsiklase, dan
meningkatnya tonus sistem parasimpatik (IKA FKUI,
2001). Beberapa faktor yang berperan dalam proses
tersebut adalah faktor genetik, sarap otonom, biokimia,
imunologis, infeksi, endokrin, psikologi dan faktor
lingkungan (IKA FKUI, 2001).

Triggers

Each individual child will have a different trigger and may

have one or more.

If triggers are known, steps can be taken to avoid them.

Asthma Triggers
Non allergic
Allergic
Exercise
Pollens
Colds and viral
Spores,moulds
infections
House dust mite
Stress
Animals
Temperature changes
Food
i.e. cold damp air
Chemicals
Cigarette smoke
Emotion (fear, anxiety,
laugh, crying)
Endocrine:
menstruation, pregnant
Potential asthma trigger activities at
school
exercise (especially in cold/damp weather)
Substances used in science, food technology or art
Indoor pets/ fur, feathers, cat allergen.
Grass/playing fields/. (Tree or grass pollen, moulds and
spores from leaves.
Dust, or dampness (mould) in building.
A cold will often cause an increase of symptoms and
could provoke an attack
 Pathogenesis and Definition

Key points
Chronic inflammatory disorder of the airways
Immunohistopathologic features
denudation of airway epithelium
collagen deposition beneath basement membrane
edema
mast cell activation
Patofisiologi

Allergen masuk ke saluran nafas/pencetus dari dalam

merangsang system imun membentuk Ig E pada permukaan
mastosit saluran nafas ikatan allergen dengan IgE menyebabkan
pelepasan mediator kimia (Histamin,leukotrein, prostaglandin,
eosinophil) Selanjutnya akan terjadi degradasi dinding dan
degranulasi sel mast. Mediator kimia akan bereaksi langsung
dengan reseptor di mukosa bronkus sehingga menurunkan siklik-
AMP dan kemudian akan terjadi bronkokontriksi. Mediator kimia
juga dapat menyebabkan iritasi reseptor iritant dan juga akan
menyebabkan bronkokontriksi bronkokontriksi, hipersekresi
kelenjar sub mukosa, infiltrasi sel radang, sesak nafas terutama saat
ekspirasi, rasa tertekan pada dada, batuk-batuk, suara nafas
wheezing ventilasi paru berkurang dengan distribusi tidak merata,
difusi gas menurun hipoksemia dan hiperkapnia asidosis
respirastory (pada asma berat)
 Child-onset asthma
Associated with atopy
IgE directed against common environmental
antigens (house-dust mites, animal proteins,
fungi
Viral wheezing Infants/children, allergy/allergy
history associated with continuing asthma
through childhood
 Adult-onset asthma
Many situations
Allergens important
Non-IgE asthma have nasal polyps, sinusitis,
aspirin sensitivity or NSAID sensitivity
 Adult-onset asthma
Occupational exposure
animal products, biological enzymes, plastic resin, wood
dusts, metal
removal from workplace may improve symptoms
although symptoms persist in some
Fase Obstruksi Bronkus

Fase cepat dan spasmogenik.

Jika ada pencetus, maka akan menyebabkan peningkatan
tahanan saluran nafas yang cepat dalam 10-15 menit.
Reaksi tersebut dapat hilang segera baik spontan maupun
dengan bronkodilator seperti simpatomimetik (beta agonis).
Terdapat peninggian faktor kemotaksis netrofil sejalan
dengan meningkatnya tahanan saluran nafas. Fase cepat
ini kemungkinan besar melalui kerja histamin terhadap otot
polos secara langsung atau melalui refleks vagal.
Perubahan ini dapat dicegah dengan pemberian antagonis
histamin H1 dan H2.
Fase lambat dan lama

Rangsangan bronkus oleh alergen spesifik

menyebabkan peninggian tahanan saluran nafas yang
menghebat maksimum setelah 6-8 jam. Patogenesis
reaksi yang tergantung pada IgE akan menyebabkan
penggumpalan netrofil 4-8 jam setelah rangsangan.
Reaksi lambat mungkin juga berhubungan dengan
reaksitivasi sel mast, leukotrien, prostaglandin dan
tromboksan. Aktivasi mediator kimia ini akan
menyebabkan kontraksi otot polos bronkus yang lama
dan edema submukosa. Reaksi lambat dapat dihambat
oleh pemberian kortikosteroid dan ketotifen.
Fase inflamasi sub-akut atau kronik

Asma yang berlanjut dan tidak diobati atau tidak

terkontrol akan menyebabkan seringnya inflamasi
didalam bronkus. Hal ini menyebabkan sumbatan
bronkus oleh mukus yang lengket dan kental. Infiltrasi
eosinofil dan sel-sel mononuklear terjadi akibat faktor
kemotaksis dari sel mast. Menurut beberapa penemuan,
ditemukan bahwa mediator PAF (Platelet Activating
Factor) yang dihasilkan oleh sel mast, basofil dan
makrofag, dapat menyebabkan hipertrofi otot polos dan
kerusakan mukosa bronkus. PAF juga menyebabkan
bronkokontriksi yang lebih kuat dan sumbatan bronkus
oleh mukus dapat terjadi sampai alveoli.
Manifestasi Klinis

Manifestasi klinis yang terjadi pada klien dengan asma sangat

tergantung dengan stadium serangan dan jenis asmanya. Pada
inspirasi terlihat pernafasan cepat, dispneu, disertai dengan batuk-
batuk paroksimal, kadang-kadang terdapat suara wheezing (mengi),
fase ekspirasi memanjang dan pada inspirasi terlihat retraksi
supraklavikular, suprasternal, epigastrium. Pada asma kronik terlihat
bentuk toraks emfisematus, sedikit membungkuk kedepan, diameter
anteroposterior toraks bertambah. Pada perkusi terdengar
hipersonor seluruh thoraks, terutama pada bagian bawah posterior
(IKA FKUI, 2001). Hal ini menyebabkan terjadinya penurunan
ventilasi dengan distribusi merata yang selanjutnya akan
menyebabkan penurunan difusi gas, penurunan PO2 (hipokesmia)
dan peningkatan PCO2 (hiperkapnia). Jika berlanjut hal ini akan
menyebabkan asidosis metabolik.
 Measures of Assessment and
Monitoring
Asthma diagnosis criteria
+ episodic symptoms of airflow obstruction
Airflow obstruction partially reversible
Rontgen Photo
Pemeriksaan Penunjang

Pemeriksaan lanjutan yang diperlukan pada klien

dengan asma adalah uji faal paru, foto rontgen thoraks,
pemeriksaan whole blood count, uji kulit alergi dan
imunologi.
Uji faal paru merupakan pemeriksaan yang berguna
untuk menilai asma dan menentukan derajat obstruksi,
menilai hasil provokasi bronkus dan keefektifan regimen
terapi. Pemeriksaan uji faal paru yang penting pada
asma adalah PEFR (Peak expiratory flow respiratory),
FEV1 (Forced expiratory volume 1 second), FVC
(Volume kapasitas paksa atau force vital capacity),
FEV/FVC (IKA FKUI, 2001).
Pemeriksaan Penunjang

Hiperreaktivitas dianggap positif jika PEFR,

FEV1 turun lebih dari 15% dari nilai sebelum
uji provokasi dan setelah diberi bronkodilator
nilai normal akan tercapai lagi. Bila PEFR
dan FEV1 sudah rendah dan setelah diberi
bronkodilator naik lebih dari 15% maka hal ini
menunjukkan hiperreaktivitas positif dan tidak
perlu dilakukan uji provokasi lagi (IKA FKUI,
2001).
Peak Flow Meter
Hyper-inflated Lungs in Asthma
Pemeriksaan Penunjang

Foto Thorax Pemeriksaan ini perlu dilakukan dan

biasanya pada pemeriksaan didapatkan peningkatan
corakan paru, menyingkirkan kemungkinan adanya
penyakit lain.
Pemeriksaan lainnya adalah pemeriksaan eosinofil dan
pemeriksaan darah lengkap, untuk melihat peningkatan
jumlah eosinofil dan leukosit (bila ada indikasi infeksi).
Pemeriksaan lainnya adalah uji kulit alergi dan imunologi
dengan menggunakan berbagai macam alergen.
Pemeriksaan ini untuk melihat kemungkinan alergen
yang potensial sebagai pencetus asma pada klien. Hasil
uji kulit alergi akan dicocokkan dengan kondisi klinis dan
bila cocok, maka pencetus tersebutlah penyebabnya.
 Differences from 1991 Expert Panel
Severity classifications:
mild intermittent
mild persistent
moderate persistent
severe persistent
 Severe Persistent Asthma

Symptoms Lung Function

Continual FEV1 or PEF < 60% of
Limited physical predicted
activity PEF variability >30%
Frequent
exacerbations
Frequent nighttime
symptoms
 Moderate Persistent Asthma

Symptoms Lung Function

Daily symptoms FEV1 or PEF >
Daily use of inhaled 60% - < 80%
short-acting predicted
beta2 agonist PEF variability >30%
Exacerbations affect

activity; > 2 X/wk;

may last days
Nighttime symptoms

>1 time/wk
 Mild Persistent Asthma

Symptoms Lung Function

Symptoms > 2 X/wk FEV1 or PEF > 80%
but <1 X/day predicted
Exacerbations may PEF variability 20-
affect activity 30%
Nighttime symptoms
> 2 X/mo
 Mild Intermittent Asthma

Symptoms Lung Function

Symptoms < 2 X/wk FEV1 or PEF > 80%
Asymptomatic and predicted
normal PEF between PEF variability <
exacerbations 20%
Exacerbations brief
(few hrs - few days);
intensity may vary
Nighttime symptoms
< 2 X/mo
Masalah Keperawatan

Gangguan jalan nafas

Gangguan pola nafas
Risiko intoleransi aktivitas
Kecemasan
Kurang pengetahuan kelg
Gangguan proses keluarga
 Asthma Management

Goals of therapy
Prevent symptoms
Maintain (near) normal lung function
Maintain normal activity
Prevent exacerbations & minimize Emergency
Room visits/hospitalizations
Optimal drug, minimal problems
Patient/family satisfaction
 Recommended monitoring
Symptom & Trigger
Quality of life/functional status
Exacerbations
Drugs
Patient/provider communication & satisfaction
 Monitor using clinician assessment/patient
self-assessment
Spirometry tests
Initial assessment
Post therapy after patients symptoms and
stabilize
Minimally1-2 per years
 Written action plan based on:
Signs & symptoms &/or PEF
Patient education:
Recognition need for additional therapy
 Patient education:
How & when to do patient monitoring
 Differences from 1991 Panel

Added patient/family satisfaction to treatment

goals
Periodic assessment of 6 domains of patient
health are recommended:
Symtom & sign, pulmonary function, quality of life,
exacerbations, pharmacotherapy, patien/provider
communication, patient. satisfaction
 PF (pulmonary function) measurements
changes
Changed from 2 X daily to morning
If morning <80% of personal best PEF, more
frequent monitoring may be desired
Discussion of inconsistencies in measurement
among PF meters added
Emphasis that all patients. regardless of
severity recognize early deterioration
 Assessment Measures

Asthma treatment effectiveness

Monitor signs & symptoms - daytime, nocturnal,
early morning symptoms response to short-acting
Beta agonist
Pulmonary function (spirometry, PF)
patients with moderate-to-severe persistent asthma
should learn how to monitor PEF at home
PF during exacerbations in patient. with moderate-to-
severe asthma is recommended
 Asthma treatment effectiveness
PF monitoring
long term daily PF monitoring in moderate-to-severe
asthma is helpful
if long-term PF monitoring is NOT used, short term
period of PF monitoring is recommended
establish individuals personal best
identify time relationships between changes in PF to
exposure
evaluate response to chronic maintenance therapy
 Personal best
2-3 wk period pt. records early afternoon PEF
Measure after each use of short-acting beta-2
agonist for symptom relief
Dont use outlyer PEF values
 Asthma treatment effectiveness
Monitoring quality of life/functional status
missed work, school
activities
sleep
changes in caregivers activities due to childs asthma
Monitoring asthma exacerbation history
self-treated, or by Helath Care providers
 Asthma treatment effectiveness
Monitoring asthma exacerbation history
unscheduled visits/telephone calls/urgent or emergent
care
frequency, severity & causes of exacerbations
hospitalization info - length of stay, intubation, ICU
 Asthma treatment effectiveness
Monitoring Drug Therapy
patient compliance
inhaler technique
frequency of use the short-acting beta2 agonist
frequency of oral steroid burst therapy
dose changes of inhaled anti-inflammatory meds.
 Asthma treatment effectiveness
Periodic assessment by clinician and patient
clinician assessment
medical history and physical exam with PFT
mild intermittent-to-mild persistent asthma under control for
3 mos. should be reassessed Q 6 mos
uncontrolled &/or severe persistent should be seen more
often
 Asthma treatment effectiveness
Periodic assessment by clinician and patient
patient self-assessment
daily diary - symptoms, PF, med. use
periodic self-assessment filled out at the time of the clinic
visit - self perception of asthma control, self-skills,
satisfaction
Drug to Treat Asthma

Mild symptoms: short-acting beta2 agonist

every 4 to 6 hours.
Moderate to severe exacerbation: short-
acting beta2 agonist plus oral corticosteroids.
For seasonal allergy induced asthma
Cromolyn Sodium can be added.
Quick Relief

Short-acting, inhaled, beta 2 agonist, as

needed.
Albuterol, levalbuterol, Proventil

Classification Pharmacologic: adrenergic

Classification Therapeutic: bronchodilator
Action: binds to beta2 adrenergic receptors in
airway smooth muscle. Decreased
intracellular calcium relaxes smooth muscle
airways. Relaxation of airway smooth muscle
with subsequent bronchodilation. Relatively
selective for beta 2 (pulmonary) receptors.
Beta 2 Agonist

Side effects: nervousness, restlessness,

tremor, chest pain and palpitations.
Nursing implications:
Assess lung sounds, pulse and blood pressure.
Monitor pulmonary function tests.
Observe for bronchospasm listen for wheezing.
Beta2 Agonist

Rescue drug short acting beta2- adrenergic

agonist used for prevention and treatment of
bronchocontriction.
Onset 15 to 30 minutes
Peak 60 to 90 minutes
Duration 3-6 hours
How Provided

Provided in extended-release tablet

Albuterol syrup
Nebulizer or dry powder inhaler
Often used in exercise induced asthma
Take 15 minutes before exercise
Albuterol
Albuterol - Nebulizer
Directions for use of inhaler

Shake well
Exhale (breathe out) through your nose while
keeping mouth shut
Close lips around mouth piece
Take slow, deep breath through the
mouthpiece as you press down on container
to release the medication
Hold breath for 5-10 seconds
Exhale slowly
Teaching

May give up to 3 treatments at 20 minute

intervals
If no relief need to call emergyny contact
Long Term Control

Mild-intermittent
Symptoms 2 days/week or less
Treat acute exacerbations with
Beta 2 agonist
Short course of systemic corticosteroid
prednisone.
Mild Persistent Asthma

Along with Beta 2 short term add:

Low-dose inhaled corticosteroids
Leukotriene modifier
Theophylline PO (not used as often)
Moderate Persistent Asthma

Daily symptoms
Inhaled corticosteroids
Long-acting beta 2 agonist
Leukotriene or theophylline
Corticosteroids

Long term control of asthma

Inhaled by Nebulizer or metered dose inhaler
For an infant hold the Nebulizer with a firm fitting
mask to the infant or small childs face
Metered dose have client rinse and spit after
dose to avoid developing thrush
Action of Corticosteroids

Suppress inflammation in the airways by

inhibiting
Movement of fluid and protein into tissues
Migration and function of neutrophils and
eosinophils WBCs
Synthesis of histamine in mast cells
Production of pro-inflammatory substances
Uses

Severe asthma used when multiple doses

of inhaled beta2 agonists are not beneficial
PO prednisone
IV methyl prednisone
In chronic asthma inhaled
COPD not as effective as the acute /
chronic asthma
When to call MD or go to ED

Tight chest wheezing difficulty breathing

Symptoms not relieved by home meds.
3 treatments with short-acting beta 2 agonist
such as albuterol with no relief.
Emergency Treatment

Epinephrine IV or Sub lingual

For life threatening asthma when inhaled
short acting beta 2 drugs have been tried
either prior to coming to the ED or in the ED.
IV corticosteroids methyl prednisone or
Solu-medrol.
Epinephrine 1 to 10,000 or 0.1 mg/mL
Epinephrine 1:1000 - 1 mg/mL
Intermediate Acting Corticosteroid

Brand name: Solu-medrol

Classification Pharmacologic: corticosteroid
(systemic)
Classification Therapeutic: antiasthmatic
Action: Suppresses inflammation and the
normal immune response.
Methylprednisone

Adult dosing: 40 to 250 mg every 4 to 6 hours

Pediatric dosing: 2 mg / kg / dose in asthma.
FAMILY EDUCATION

Trigger control
Medication control
Recognising asthma attact
Activity adaptation
Regular pulmonary function test (twice a
year)
Family coping mechanism
How can teachers help
Ensure all asthmatic children take any necessary treatment
before sport or activities.
Ensure relievers are readily available when required/never
locked away.
Check with the child, parent, school nurse that medicines are
supplied for school outings
Be aware that some materials brought into the classroom or
certain activities may trigger a childs asthma.
Make a point of speaking to parents of children needing to use
their reliever inhaler more often than usual.
Know what to do in an emergency
How Parents Can Help
Inform the school about their childs asthma, its treatment
and their childs triggers.
Ensure that child always has an in date reliever
inhaler and a spacer - this may be in addition to the
inhaler and spacer that the child carries on them at
school.
Keep school informed of their childs illnesses i.e,
during a cold.
Keep school updated about changes in treatment.
Ensure the school have up-dated contact numbers for
parent/carers.
Recognising an asthma attack
Breathlessness
Wheeze
Cough
Unable to talk in sentences
Working harder to breathe
Symptoms not helped by using reliever (blue
inhaler)
Loss of colour
Agitation/fear
Panic attack/hyperventilation

Rapid breathing
Dizziness
Tingling in feet/hands
Faint
Placebo effect of reliever inhaler
Helped by slowing down breathing, and
distraction.
What to do in an emergency
A child is having a more severe attack if :

The child is distressed and having difficulty in speaking full

sentences due to breathlessness
Child is breathless and getting exhausted
The blue reliever has not helped
The childs lips turn blue
Dial 999 - state severe/life threatening asthma
Give child their reliever (blue) inhaler using a spacer at a
ratio of 1 puff per 30 seconds, until ambulance arrives.
Contact parents.
TEACHERS Treating a wheezy child
MILD ACTION

IF CHILD HAS any of the following CONTINUE 4 HOURLY

A MILD COUGH AND WHEEZE RELIEVER INHALER.
REQUIRES THE RELIEVER INHALER NO MORE THAN CONTACT
2PUFFS EVERY 4 HOURS PARENT IF
NOT BREATHING QUICKLY THERE IS NO
ABLE TO CONTINUE DAY TO DAY ACTIVITIES IMPROVEMENT
AFTER 3 DAYS.

ACTION

MODERATE IMMEDIATELY
IF CHILD IS; CONTACT PARENT.
WHEEZING AND BREATHLESS AND THE
RELIEVER INHALER IS REQUIRED MORE THAN CHILD NEEDS AN
2 PUFFS EVERY 4 HOURS APPOINTMENT WITH GP
THAT DAY.
Use the GP out
of hours service
or go to the all
day heath
centre if you are
unable to get an
appointment.

Dial 999
SEVERE IMMEDIATELY
IF CHILD IS; STATE SEVERE/LIFE
BREATHLESS, AND IS WORKING HARD TO THREATENING
BREATHE/USING TUMMY MUSCLES TO ASTHMA
BREATHE.
UNABLE TO COMPLETE A SENTENCE AND IS GIVE 1 PUFF OF
GETTING TIRED BLUE RELIEVER
INHALER VIA
SPACER EVERY 30
SECONDS- UNTIL
AMBULANCE
LIFE THREATENING ARRIVES
IF CHILD IS;
HAVING SEVERE DIFFICULTY IN
BREATHING
HAS BLUE LIPS
IS PALE DROWSY OR WEAK
Treating a wheezy child
MILD ACTION

IF CHILD HAS any of the following CONTINUE 4 HOURLY

A MILD COUGH AND WHEEZE RELIEVER INHALER.
REQUIRES THE RELIEVER INHALER NO MORE THAN CONTACT
2PUFFS EVERY 4 HOURS PARENT IF
NOT BREATHING QUICKLY THERE IS NO
ABLE TO CONTINUE DAY TO DAY ACTIVITIES IMPROVEMENT
AFTER 3 DAYS.

ACTION

MODERATE IMMEDIATELY
IF CHILD IS; CONTACT PARENT.
WHEEZING AND BREATHLESS AND THE
RELIEVER INHALER IS REQUIRED MORE THAN CHILD NEEDS AN
2 PUFFS EVERY 4 HOURS APPOINTMENT WITH GP
THAT DAY.
Use the GP out
of hours service
or go to the all
day heath
centre if you are
unable to get an
appointment.

Dial 999
SEVERE IMMEDIATELY
IF CHILD IS; STATE SEVERE/LIFE
BREATHLESS, AND IS WORKING HARD TO THREATENING
BREATHE/USING TUMMY MUSCLES TO ASTHMA
BREATHE.
UNABLE TO COMPLETE A SENTENCE/TAKE FLUIDS GIVE 1 PUFF OF
AND IS GETTING TIRED BLUE RELIEVER
INHALER VIA
SPACER EVERY 30
SECONDS- UNTIL
AMBULANCE
LIFE THREATENING ARRIVES
IF YOUR CHILD IS;
HAVING SEVERE DIFFICULTY IN
BREATHING
HAS BLUE LIPS
IS PALE DROWSY OR WEAK
Does your school have a good asthma
policy?
Are all asthmatic children in the school identified ?
Yearly letters asking if child has asthma, registration
forms.
Do all asthmatic children have immediate access to
reliever medication?
Are staff trained in the procedure for an asthmatic
attack?
If a teacher is concerned about a pupils asthma, they
should approach parent first then school nurses.
References
Asthma UK 2005
Image of asthma lungs http://www.nhlbi.nih.gov
Image of inhaler medication obtained with thanks from National
University Hospital Singapore nuh.com.sg
Gruffydd-Jones et al, Understanding patient perceptions of
asthma; results of the Asthma Control and Expectations survey.
Int.J Clin Practice, March 2002
Smith NM the Needs of people with asthma Survey and initial
presentation of data. Asthma J 2001 133-137
British Thoracic Society BTS/SIGN. British Guidelines on
Asthma Management. Thorax 2003. updated 2009 and 2011.
Additional literature
Asthma UK Asthma in schools policy
Asthma UK School Asthma Pack
Kasus
Seorang anak laki-laki, usia 8 tahun dibawa oleh ibunya ke poliklinik anak
sebuah rumah sakit. Ibu mengatakan sejak dua hari yang lalu anaknya
mengalami sesak nafas disertai batuk (terutama pagi hari), nafas berbunyi
ngiik dan wajah tampak pucat. Hal tersebut terjadi setelah anak bermain
bola bersama teman sekelasnya. Anak mengatakan lapangannya sangat
berdebu, ibu sudah menyarankan anak untuk tidak ikut, namun anak tetap
memaksa ikut bermain bersama temannya karena merupakan ekstra
kulikuler sekolah. Kejadian sesak ini sudah terjadi kedua kalinya dalam 1
minggu terakhir, anak pernah juga sesak saat malam hari 2x dalam satu
bulan ini. Sesak biasanya membaik setelah anak istirahat. Pada
pemeriksaan fisik didapatkan respirasi rate 24x/menit, heart rate
100x/menit, suhu 37,4C, dyspnea (+),terdapat wheezing, ekspirasi
memanjang. Anak direncanakan akan dilakukan pemeriksaan spirometri.
Saat ini anak diberikan nebulisasi dengan obat albuterol 0,09 mg, kemudian
perawat memposisikan anak dan melakukan nebulisasi. Ibu menanyakan
apa yang harus dilakukan saat anak sesak di rumah dan apakah nebulisasi
juga bisa dilakukan di rumah?
Masalah Keperawatan

Bersihan jalan nafas tidak efektif

Resiko pola nafas tidak efektif
Risiko intoleransi aktivitas
Risiko gangguan proses keluarga (penyakit
kronis)