NTA Level 4 • Semester 1 • PST04102

Identification of Patients with Asthma

Disease Control and Prevention • Source Session/Topic 38

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Session 38: Identification of Patients with Asthma

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Describe Causes of Asthma

• Describe Major Signs and Symptoms of Asthma

• Explain Treatment of Asthma

• Describe Prevention and Control of Asthma

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Handout 38.1: Bronchial Asthma – Precipitating or Aggravating Factors

SESSION OVERVIEW

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Cause(s) of Asthma (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|ASK students to brainstorm on the following question: |

| |

|What are the causes of asthma? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Asthma is a respiratory tract disorder characterized by chronic

inflammatory reversible airways obstruction.

• Involves the respiratory system constricting the airway

• Bronchial asthma may be either episodic (the patient has no respiratory

symptoms between episodes, or signs of asthma.

• Paroxysm of wheeze and dyspnoea may occur at any time and can be of

sudden onset

• May be extrinsic (this occurs to young people due to allergy) or

intrinsic (occurs in older people)

Causes

• The symptoms are caused by constriction of bronchial smooth muscle

(bronchospasm), oedema of bronchial mucous membrane and blockage of the

smaller bronchi with plug of mucous

• It can also be triggered by factors like allergens, infections, exercise,

tobacco smoke inhaled chemicals and drugs for example aspirin

• High risk jobs such as farming, painting, janitorial work and plastic

manufacturing

• Generally it can be caused by a complex interaction of environmental and

genetic factors

[pic][pic]Handout 38.1: Bronchial Asthma – Precipitating or Aggravating

Factors

STEP 3: Major Signs and Symptoms of Asthma (10 minutes)

• Signs and Symptoms of Asthma:

o Wheezing

o Productive cough

o Shortness of breath (dyspnoea)

o Chest tightness

o Increased respiratory rate

o Increased heart rate

o Diaphoresis (excessive sweating)

o Decreased exercise tolerance

Cough and wheeze are common during the night and may disturb sleep

STEP 4: Treatment of Asthma (10 minutes)

• Acute severe asthma and life threatening asthma in adult

o Perform pre-referral treatment:

▪ Nebulized salbutamol or inhaled salbutamol (if available)

▪ Hydrocortisone 200mg i.v slowly (if available)

▪ Aminophylline 250mg i.v slowly or tabs

▪ Monitor vital signs

o Refer to hospital immediately

• Treatment at the hospital

o Oxygen 40-60% via nasal prongs or face mask if available

o Nebulized salbutamol or inhaled salbutamol delivered by a spacer

o Hydrocortisone 200mg i.v slowly then oral prednisolone 30-60mg for 5-7

days

o Aminophylline 250mg i.v slowly or tabs when therapy above fails

STEP 5: Prevention and Control of Asthma (50 minutes)

|Activity: Small Group Discussion ( 10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|What are the measures for the prevention and control of asthma? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Patient Education

• Should begin at the time of diagnosis and be revisited in every

subsequent consultation.

• Education involves the patient understanding the nature of asthma, the

practical skills necessary to manage asthma successfully for example

using inhaler devices and monitor the effect of treatment

• Patients should appreciate the differences between the reliever

medication (bronchodilator) and the controller medication (anti-

inflammatory)

Prevention of Asthmatic Attack

• Avoidance of exposure to allergen to which patients are sensitive to:

o Animal dander: Avoid contact with dogs, cats, horses or other animals.

o Feathers in pillows or quilts: Substitute latex foam pillows and

terylene quilts.

o Avoid all preparations of relevant drugs for example beta-blockers,

aspirin and other nonsteroidal anti-inflammatory drugs if the patient

is sensitive.

o Food: Identify and eliminate from diet.

o Industrial chemicals e.g. isocyanates, epoxy resins, perfumes: Avoid

exposure to chemical or change occupation.

o Do not smoke and avoid environmental smoke.

o Pollens: Try to avoid exposure to flowering vegetation and keep the

bedroom windows closed.

o Avoid exertion during high levels of pollution.

STEP 6: Key Points (5 minutes)

• Asthma can either be caused by a complex interaction of environmental and

genetic factors.

• Major signs and symptoms includes wheezing, shortness of breath

(dyspnoea) and chest tightness

• Severe bronchial asthma is an emergency which need urgent attention.

• Educating patients with bronchial asthma should start early when

diagnosis is established in order to carry out necessary precautions.

STEP 7: Evaluation (10minutes)

• What are the cause(s) of asthma?

• What are the major signs and symptoms of asthma?

• What is the treatment of asthma?

• What are the measures for prevention of asthma?

STEP 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation on how environmental and genetic factors cause |

|Asthma? |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Braunwald, E. & Fauci, A.N. (2008).Harrison’s Principles of Internal

Medicine (17thed.). Oxford: McGraw Hill.

Davidson, S. (2006). Principles and Practice of Medicine (20thed.).

Churchill: Livingstone.

Kumar, P.J. & Clark, M. (2006).Textbook of Clinical Medicine (6thed.).

Churchill: Livingstone

MoHSW. (2013). Standard Treatment Guidelines & National Essential

MedicinesList (4thed.). Dar es Salaam: MoHSW

Wikipedia. (2010). Asthma Before-After.Retrieved

fromhttp://en.wikipedia.org/wiki/File:Asthma_before-after.png

|[pic] |Handout 38.1: Bronchial Asthma – Precipitating or |

| |Aggravating Factors |

[pic]

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