Asthma is a chronic inflammatory disorder affecting the airways, particularly the bronchi and bronchioles. It is characterized by reversible episodes of airway narrowing and inflammation, leading to intermittent breathing difficulty. Asthma management involves recognizing early symptoms, preventing triggers, and providing prompt treatment during acute attacks.
This guide covers:
- Pathophysiology of asthma
- Signs and symptoms
- Peak expiratory flow rate zones
- Asthma triggers
- ABG interpretation during an attack
- Pharmacology (BAM & SLM teams)
- NCLEX tips and teaching strategies
Pathophysiology of Asthma
Asthma is a chronic inflammatory disease of the major airways:
- Bronchi & bronchioles become hyperresponsive to triggers.
- Exposure to allergens or irritants causes airway inflammation, mucus production, and bronchoconstriction.
- These flare-ups are reversible with treatment, unlike COPD where airflow limitation is progressive.
Memory Trick:
A = Asthma
A = Acute attacks that come and go
Signs and Symptoms
Use the acronym ASTHMA:
- A – Accessory muscle use (critical sign: paradoxical breathing)
- S – SOB (shortness of breath) & dyspnea (critical sign: single-word dyspnea)
- T – Tight chest & tachypnea
- H – High-pitched wheezing
- M – Minimal or diminished breath sounds
- A – 3 A’s: Absent breath sounds, Air trapping, Prolonged exhalation
Critical Danger:
- Silent chest = absent breath sounds = priority emergency
- Indicates air trapping and possible respiratory arrest.
ABG Interpretation in Severe Asthma
During acute exacerbations:
- pH < 7.35 = acidosis
- PaCO₂ > 45 mmHg = respiratory acidosis (CO₂ retention)
- PaO₂ < 80 mmHg = hypoxemia
First sign of hypoxia:
- Mental status changes: agitation, restlessness, drowsiness.
Status Asthmaticus:
- Severe, prolonged asthma attack unresponsive to standard treatment.
- Requires endotracheal intubation.
Peak Expiratory Flow Rate (PEFR) Zones
Green Zone (80–100% of personal best)
- Asthma is under control
- Continue maintenance therapy
Yellow Zone (50–79%)
- Asthma is not under control
- Rescue inhaler every 4 hours for 1–2 days
- Call HCP for adjustment in medications
Red Zone (<50%)
- Emergency situation
- Immediate treatment and ER care needed
Correct Order for Peak Flow Measurement:
- Stand or sit upright
- Set meter to zero
- Inhale deeply
- Place mouthpiece in mouth and seal lips
- Exhale forcefully
- Repeat 3 times
- Record the highest reading
Common Asthma Triggers
A – Allergens (dander, dust, pollen) & elevated eosinophils
S – Smoking (including secondhand)
S – Stress (emotional or physical)
Other triggers include sickness (flu, URI), cold weather, and strenuous activity (though exercise is encouraged with preventive inhaler use).
Drugs to Avoid in Asthma
- N – NSAIDs (naproxen, aspirin, ibuprofen, indomethacin, ketorolac)
- B – Beta-blockers (especially nonselective: propranolol)
- Can trigger bronchospasm and worsen asthma control.
Pharmacology – Asthma Management
BAM Team – Bronchodilators (Rescue)
- B – Beta-2 agonists: Albuterol (first-line for acute attacks)
- A – Anticholinergics: Ipratropium (reduces secretions, dilates airways)
- M – Methylxanthines: Theophylline (rarely used, narrow therapeutic range 10–20 mg/dL)
NCLEX Tip:
BAM = rescue and rapid relief.
SLM Team – Anti-Inflammatories (Maintenance)
- S – Steroids (e.g., Beclomethasone) – rinse mouth after use to prevent thrush.
- L – Leukotriene inhibitors (e.g., Montelukast) – long-term control.
- M – Mast cell stabilizers (e.g., Cromolyn) – prevent allergen-induced attacks.
NCLEX Tip:
SLM = slow-acting, prevent inflammation, not for acute attacks.
Nursing Priorities in Acute Asthma Attack
Use the AIM mnemonic:
- A – Albuterol (short-acting beta-2 agonist) first
- I – Ipratropium second
- M – Methylprednisolone last (reduces inflammation)
Inhaler Education
- Shake inhaler before use (if applicable)
- Inhale medication deeply and hold breath for 10 seconds to allow deposition in airways
- Wait 1–2 minutes between puffs
- Always rinse mouth after using steroid inhalers
Common NCLEX-Style Questions
Example 1:
Patient with severe asthma: Which medications should be given?
✅ Albuterol inhaler
✅ Nebulizer Ipratropium
✅ IV Methylprednisolone
❌ Inhaled salmeterol (long-acting, not for acute attacks)
❌ IV methamphetamines (not a treatment)
Example 2:
Kaplan teaching question: “Stress does not cause my asthma attacks” → incorrect. Stress is a trigger.
Summary Table – Asthma Care
| Category | Key Points |
|---|---|
| Pathophysiology | Chronic inflammation + reversible bronchoconstriction |
| Key Symptoms | SOB, wheezing, chest tightness, accessory muscle use |
| ABG Changes | Low pH, High PaCO₂, Low PaO₂ |
| First Sign of Hypoxia | Mental status change |
| Peak Flow Zones | Green = controlled, Yellow = caution, Red = emergency |
| Rescue Medications (BAM) | Albuterol, Ipratropium, Theophylline |
| Maintenance Meds (SLM) | Steroids, Leukotriene inhibitors, Mast cell stabilizers |
| Triggers | Allergens, Smoke, Stress |
| Drugs to Avoid | NSAIDs, Beta-blockers |
FAQs
Q1. Can asthma be cured?
No, but it can be effectively controlled with medication and trigger avoidance.
Q2. What is status asthmaticus?
A life-threatening asthma attack that does not respond to usual medications.
Q3. Why rinse mouth after steroid inhalers?
To prevent oral thrush (fungal infection).
Q4. How is peak flow used in asthma?
It measures how well air moves out of the lungs, helping detect worsening asthma before symptoms become severe.
Q5. Can beta-blockers be used in asthma?
Only with caution, and preferably selective beta-1 blockers, as nonselective beta-blockers can cause bronchospasm.
