Definition:
Bronchial asthma is a chronic inflammatory airway disorder characterized by reversible airway obstruction, bronchial hyperresponsiveness, and excessive mucus production. Asthma is a common topic in the NCLEX-RN, requiring knowledge of pathophysiology, triggers, medication management, nursing interventions, and patient education.
Pathophysiology:
Asthma involves three key processes:
- Airway Inflammation – Triggered by allergens, irritants, or infections.
- Bronchospasm – Smooth muscle constriction leads to airway narrowing.
- Excess Mucus Production – Further obstructs airflow.
Key Mechanisms::
- Mast cells, eosinophils, and T-lymphocytes play a role in inflammation.
- Histamine and leukotrienes contribute to bronchoconstriction and mucus secretion.
Triggers (Common NCLEX Question Topic):
✅ Allergens (pollen, dust mites, pet dander, mold).
✅ Irritants (smoke, strong odors, air pollution, cold air).
✅ Respiratory infections (viral or bacterial).
✅ Exercise-induced asthma (especially in cold/dry air).
✅ Medications (NSAIDs, beta-blockers).
✅ Gastroesophageal reflux disease (GERD) – Acid reflux worsens airway irritation.
Signs and Symptoms:
Mild to Moderate | Severe (Status Asthmaticus – Life-Threatening) |
|---|---|
Wheezing | Absent breath sounds (silent chest) |
Dyspnea | Severe dyspnea, unable to speak |
Cough | Cyanosis (late sign) |
Chest tightness | Use of accessory muscles |
Prolonged expiration | PCO₂ retention (respiratory acidosis) |
NCLEX-RN: Asthma Management (Stepwise Approach):
1. Quick-Relief (Rescue) Medications – Used for Acute Attacks
Medication Class | Examples | Contraindications |
|---|---|---|
Short-Acting Beta₂-Agonists (SABAs) | Albuterol, Levalbuterol | Avoid excessive use (tachycardia, tremors). Not for daily use. |
Anticholinergics (Short-Acting Muscarinic Antagonists – SAMA) | Ipratropium | Avoid in patients with glaucoma or BPH. |
Systemic Corticosteroids (Short-term use only) | Prednisone, Methylprednisolone | Long-term use causes osteoporosis, hyperglycemia, immunosuppression. |
NCLEX Tip: Albuterol is the #1 rescue drug for acute asthma attacks!
2. Long-Term Control (Preventive) Medications
Medication Class | Examples | Contraindications |
|---|---|---|
Inhaled Corticosteroids (ICS) | Fluticasone, Budesonide, Beclomethasone | Rinse mouth after use (prevents oral candidiasis). |
Long-Acting Beta₂-Agonists (LABAs) – Always Combined with ICS | Salmeterol + Fluticasone (Advair), Formoterol + Budesonide (Symbicort) | NEVER use as monotherapy – increased risk of asthma-related death. |
Leukotriene Modifiers | Montelukast, Zafirlukast | Risk of neuropsychiatric effects (depression, suicidal thoughts). |
Mast Cell Stabilizers | Cromolyn Sodium | Not effective for acute attacks. |
Methylxanthines | Theophylline | Narrow therapeutic index (toxicity: tachycardia, arrhythmias, seizures). |
NCLEX Tip: LABAs (e.g., Salmeterol) MUST be combined with an inhaled corticosteroid!
Peak Flow Meter – NCLEX-RN Key Concept:
A peak expiratory flow rate (PEFR) meter measures asthma control. Patients should measure daily to detect worsening symptoms.
Zone | PEFR (%) | Action |
|---|---|---|
Green (Good Control) | >80% of personal best | Continue regular medications. |
Yellow (Caution – Use Rescue Inhaler) | 50-79% | Use SABA (Albuterol), contact provider if no improvement. |
Red (Medical Alert – Seek Help Immediately) | <50% | Use SABA, go to ER if symptoms persist. |
NCLEX Tip: A patient in the Red Zone requires immediate medical attention!
Status Asthmaticus – Life-Threatening Complication
A severe, prolonged asthma attack unresponsive to initial treatment.
Signs
- Severe dyspnea and wheezing absent (silent chest).
- Respiratory acidosis (PaCO₂ rising).
- Pulsus paradoxus (SBP drops >10 mmHg during inhalation).
- Cyanosis and mental status changes (hypoxia).
Emergency Treatment
- Oxygen (high-flow, 100%).
- Short-acting beta₂-agonist (Albuterol) via nebulizer.
- Systemic corticosteroids (IV Methylprednisolone).
- IV fluids (for dehydration from tachypnea).
- Magnesium sulfate IV (for severe bronchospasm).
- Intubation & mechanical ventilation if no improvement.
NCLEX Tip: If a patient with status asthmaticus suddenly has silent breath sounds, this is a respiratory failure warning sign!
Patient Education (NCLEX-RN Priority Questions)
✅ Avoid asthma triggers (smoking, allergens, strong odors, cold air).
✅ Use bronchodilators BEFORE inhaled corticosteroids (Allows better medication absorption).
✅ Rinse mouth after corticosteroids to prevent thrush.
✅ Use peak flow meter daily to monitor symptoms.
✅ Seek emergency help if lips/fingernails turn blue or if speaking is difficult.
References:
- American Lung Association. (2022). Asthma: Symptoms, causes, and treatments. Retrieved from https://www.lung.org
- Global Initiative for Asthma (GINA). (2023). Global strategy for asthma management and prevention. Retrieved from https://ginasthma.org
- Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
- Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2023). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.
- McCance, K. L., & Huether, S. E. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier.
- National Institutes of Health (NIH). (2022). Asthma: Clinical guidelines and treatment recommendations. Retrieved from https://www.nih.gov
- Pagana, K. D., & Pagana, T. J. (2021). Mosby’s diagnostic & laboratory test reference (15th ed.). Elsevier.
- Potter, P. A., & Perry, A. G. (2021). Fundamentals of nursing (10th ed.). Elsevier.
- Smeltzer, S. C., & Bare, B. G. (2020). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Lippincott Williams & Wilkins.
- Townsend, M. C. (2021). Essentials of psychiatric mental health nursing (8th ed.). F.A. Davis.