Introduction

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to

describe progressive lung diseases including emphysema, chronic bronchitis, refractory

(non-reversible) asthma, and some forms of bronchiectasis. This disease is

characterized by increasing breathlessness.

Many people mistake their increased breathlessness and coughing as a normal

part of aging. In the early stages of the disease, you may not notice the symptoms.

COPD can develop for years without noticeable shortness of breath. You begin to see

the symptoms in the more developed stages of the disease.

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows

the airways. Asthma causes recurring periods of wheezing (a whistling sound when you

breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs

at night or early in the morning.

Asthma affects people of all ages, but it most often starts during childhood. In the

United States, more than 25 million people are known to have asthma. About 7 million

of these people are children.

To understand asthma, it helps to know how the airways work. The airways are

tubes that carry air into and out of your lungs. People who have asthma have inflamed

airways. The inflammation makes the airways swollen and very sensitive. The airways

tend to react strongly to certain inhaled substances.

 When the airways react, the muscles around them tighten. This narrows the

airways, causing less air to flow into the lungs. The swelling also can worsen, making

the airways even narrower. Cells in the airways might make more mucus than usual.

Mucus is a sticky, thick liquid that can further narrow the airways.

This chain reaction can result in asthma symptoms. Symptoms can happen each

time the airways are inflamed. Asthma has no cure. Even when you feel fine, you still

have the disease and it can flare up at any time.

However, with today's knowledge and treatments, most people who have asthma are

able to manage the disease. They have few, if any, symptoms. They can live normal,

active lives and sleep through the night without interruption from asthma. If you have

asthma, you can take an active role in managing the disease. For successful, thorough,

and ongoing treatment, build strong partnerships with your doctor and other health care

providers.

According to the Global Asthma Report, approximately 11 million or 1 out 10

Filipinos are suffering from asthma, yet 98 percent of Filipino asthma patients continue

to lack proper treatment.

“This means that asthma patients will only use medication when they have attacks

believing that as long as there are no attacks they will be okay. As such, they believe

that it is enough that they have available medicines to be taken on an as-needed basis,”

shares Dr. Sylvia Yang, World Asthma Day committee chair of the Philippine College of

Chest Physicians (PCCP).

 I. DEMOGRAPHIC DATA
Initials of client: M.T Date of Interview: Dec. 01, 2017
Address: Brgy.Pooc, Silang, Cavite Primary Informant: Patient
Age: 62 years old
Birth Date: Nov 02, 1955
Birth Place: Silang, Cavite
Sex: Female
Highest educational attainment: Highschool Graduate
Religion: Roman Catholic
Occupation: Caretaker
Monthly Income: 10,000 highest and 8,000 lowest

II. PAST MEDICAL HISTORY

Client had childhood disease such chicken pox and common colds in her

elementary days. She also had mumps that her mother uses “Tina” with vinegar to

manage it. According to the patient these intervention was effective to her because

her mumps was cured. In her current age she still experienced fever, cough and

common colds to manage those diseases she took paracetamol, and neozep. Her

diseases commonly lasted within 3 to 4 days. If untreated with this regimen she then

goes to albularyo.

She did not suffer from any injuries or accidents before. She does not experience

any operation. Client does not complete her immunization. According to Public

Health Nursing that the commitment of our country to Universal Child Immunization

(UCI) Goal acceleration of Expanded Program on Immunization (EPI) coverage had

 begun in 1986 and the client birth year is 1985. Therefore this certifies that the client

does not fully immunize during childhood.

III. HISTORY OF PRESENT ILLNESS

The client had her asthma when she was 7 years old. Her disease triggers when

the weather is either hot or cold and also when she was doing physical activity like

cleaning the house.

Last October 2016 the client experienced difficulty of breathing and chest pain.

She manage it by drinking Salbutamol tablet 2mg. upon taking the medication after a

few minutes she then feels relieved and can breathe normally.

IV. CAUSES

Doctors have identified the two main conditions that cause asthma symptoms:

inflammation and airway constriction.

 Inflammation

With asthma, the inside walls of the airways are swollen, or inflamed. This

inflammation makes the air passages particularly sensitive to irritants and asthma

triggers. The swelling narrows the air passages, making it difficult for air to pass

through the airways. This makes it hard to breathe normally.

 Airway constriction

When the airways come into contact with certain asthma triggers, the

muscles around the airways tighten. This causes the air passages to become

even narrower. It also causes a tight feeling in the chest, or feels like a rope is
 being tightened around the chest. Mucus can get lodged in the narrowed

airways, causing more trouble with breathing.

 Asthma triggers

The triggers that cause the inflammation and airway constriction can vary

from patient to patient. Understanding the triggers is essential to managing

asthma.

Common asthma triggers include:

 stress and strong emotions

 pollen
 physical activity
 dust mites and cockroaches
 allergic reaction to food or
 mold
sulfites
 pet hair and dander
 food preservatives
 changes in weather,
 heartburn/acid reflux
especially cold air
 certain medications, such as
 respiratory infections, such as
aspirin or beta blocker
the common cold

 smoke

V. RISK FACTORS

There are a number of factors thought to increase the risks of developing

asthma. They include the following.

 Family history

If one of the parents has asthma, then there is a greater risk of developing

asthma.
  Gender and age

Asthma is more common in children than adults. Boys are more likely to

develop asthma than girls. Risks are equal for men and women for adult-onset

asthma.

 Allergies

Sensitivity to allergens is often an accurate predictor of your potential to

develop asthma. These allergens often include:

 dust

 pet dander

 mold

 toxic chemicals

Allergens can trigger asthma attacks after you develop asthma.

 Smoking

Cigarette smoke irritates the airways. Smokers have a high risk of asthma.

Those whose mothers smoked during pregnancy or who were exposed to

secondhand smoke are also more likely to have asthma.

 Air pollution

This is the main component of smog, or ozone. Constant exposure to air

pollution raises the risk for asthma. Those who grew up or live in urban areas

have a higher risk for asthma.

 Obesity
 Children and adults who are overweight or obese are at a greater risk of

asthma. Although the reasons are unclear, some experts point to low-grade

inflammation in the body that occurs with extra weight.

 Viral respiratory infections

Respiratory problems during infancy and childhood can cause wheezing.

Some children who experience viral respiratory infections go on to have chronic

asthma.

VI. SIGNS AND SYMPTOMS

Individuals with a history of asthma earlier in life may have a recurrence of

symptoms late in life following many symptoms free years. Others may

experience symptoms for the first time as an elderly adult (adult onset asthma).

Still others may have an onset of asthma related to a specific trigger such as

allergy, gastrointestinal acid reflux (GERD), sinusitis, pulmonary infection, or

exposure to a respiratory irritant.

Elderly individuals with asthma often have persistent or recurrent cough,

shortness of breath on exertion (walking, shopping, any normal activities) or

awaken at night due to respiratory symptoms. Wheezing may or may not be

present. These symptoms are often not attributed to asthma in an elderly

individual with other medical problems that can produce similar symptoms and

therefore the appropriate treatment is often delayed until the correct diagnosis is

made.
VII. PATHOPHYSIOLOGY

Precipitating Factor Predisposing Factor

-smoking -family history
-obesity -sex
-Air pollution -age
-vial respiratory infections -allergy
-environmental factors

Atopy:
Predisposition to allergic hypersensitivity in airways

First exposure to triggers

(Sensitizes helper T cells)

Triggers of airway hyper responsiveness include:

Stimulatoin of B-cells to produce IgE, which binds to mast cell

surfaces

Activated Helper T-cells &IgE-sensitized mast cells now line the

airways

Second exposure to triggers

Early Response (0-2 hrs) Delayed Response (4-12 hrs)

Allergens cross-linked IgEs Activated mast cells & helper

on mast cells T cells release cytokines

mast cells release Induce maturation of granular

histamines, leukotrines, WBCs like eosinophils
and other inflammatory
mediators
 Eosinophils migrate into:

vasodilation Goblet cell Bronchial

hyperplasia smooth
muscle
Airway Eyes Nose Skin
contraction s
edema
Mucus
Bronchiole Rhinitis/
Secretion
constrictions sinusitis

conjunctivitis Atopic
dermatitis
Airway obstruction

Red itchy Runny

eyes, visual Nose, Skin
Ventilation During expiration: (+)
blurring sneezing rash,
of alveoli pleural pressure hives
squeezes on airways

hypoxemia

Gas is trapped Pt. need to

tachycardia within alveoli voluntary Narrower
expire airways
faster and
tachypnea more
Hyperinfiltrates
lungs forceful
Turbulent
airflow,
heard on
episodic dyspnea Chest tightness auscultation

Activating accessory respiratory muscle to Airway obstruction,

thoracic volume lungs take more time
to empty

Visible contraction of neck

muscle Prolonged expiratory
phase of breathing

ASTHMA
LEGEND:

Precipitating Factor Subeffect

Predisposing Factor Signs & Symptoms

Main Etiology Complications

Effect Disease

Continuation Progression
VIII. REVIEW OF SYSTEM

A. Functional Ability

Below is the table for Katz Index of Independence in Activities of Daily Living for
measuring the independency of the client.

*Katz Index of Independence in Activities of Daily Living

Activities Independence = 1 point Dependence = 0 point
Points (1 or 0)
No supervision, direction or With supervision, direction or
personal assistance needed personal assistance or total care
Bathing 1
Dressing 1
Toileting 1
Transferring 1
Continence 1
Feeding 1
TOTAL POINTS: 6

INTERPRETATION:

Even though patient A.H experience body weakness due to oldness she

still pushes herself to at least do some of her daily routine by herself. She still

wants to bath, dress, feed and going to toilet alone and also she does not need

assistance in transferring. However, sometimes he needs assistance while

walking because there might be possible injury that may occur while walking like

outside in their house so as part of reassurance of patient’s safety the relatives

assist her in these activity.

 B. Physical Health

PHYSICAL SIGN OR DIFFERENTIAL

SIGNS
SYMPTOM DIAGNOSES

Vital signs

Blood pressure Hypertension Adverse effects from

medication, autonomic
140/90 mmHg
dysfunction

Heart rate Normal Normal

86 bpm

Respiratory rate Increased respiratory Abnormal findings it

rate greater than 24 indicates that the patients
24
breaths per minute experience difficulty of
breathing.

Temperature Normal Normal

37.2 oC

General BMI – 30.2 Abnormal findings indicates

that the patient is
Height – 5’2”
overweight.
Weight – 75 kg

Head Symmetric face and Normal

round

Eyes Loose eye skin Normal findings it indicates

With eye glass that the client is old.
 PHYSICAL SIGN OR DIFFERENTIAL
SIGNS
SYMPTOM DIAGNOSES

Ears Hearing loss Indicates adverse effects

from medication, cerumen
impaction

Mouth, throat With dentures

Neck Smooth with any Normal findings

palpable nodule

Cardiac Normal heart sound

Pulmonary Shortness of breath Asthma

Abdomen Flat and round Normal Findings

Gastrointestinal, Atrophy of the vaginal Estrogen deficiency

genital/rectal mucosa

Constipation It indicates adverse effects

from medication,
dehydration, inactivity,
inadequate fiber intake
 PHYSICAL SIGN OR DIFFERENTIAL
SIGNS
SYMPTOM DIAGNOSES

Extremities Pedal edema Adverse effects from

medication, pressure on the
feet due to overweight

Muscular/skeletal Diminished range of Arthritis

motion, pain

back pain

Normal Gait Normal

Leg pain and Due to overweight and

weakness oldness

Skin Roughened and dry Dry skin may indicate

skin dehydration.
Thinned skin Normal findings it indicates
that client is in elderly
Saggy and wrinkled
stage.

C. Cognition and Mental Health

Mini-Cognitive Assessment Instrument

Step 1. Ask the patient to repeat three unrelated words, such as “ball,” “dog,”
and “window.”

Step 2. Ask the patient to draw a simple clock set to 10 minutes after eleven
o'clock (11:10). A correct response is drawing of a circle with the numbers
placed in approximately the correct positions, with the hands pointing to the 11
and 2.
Step 3. Ask the patient to recall the three words from Step 1. One point is
given for each item that is recalled correctly.

Interpretation

NUMBER OF ITEMS CLOCK

CORRECTLY DRAWING TEST INTERPRETATION OF
RECALLED RESULT SCREEN FOR DEMENTIA

0 Normal Positive

0 Abnormal Positive

1 Normal Negative

1 Abnormal Positive

2 Normal Negative

2 Abnormal Positive

3 Normal Negative

3 Abnormal Negative

Adapted with permission from Ebell MH. Brief screening instruments for dementia in
primary care. Am Fam Physician. 2009;79(6):500, with additional information from
reference 47.

D. Socio-environmental Circumstances

The client was living with her eldest son’s house for 25 years. According to

her she was happy and contented with her situation right now. Living with his son
 together with her grandchildren makes her feels happy and it makes her

stronger. According to her she was still able to go outside and talk with her

friends. And also she was able to go in their barangay for zumba but according to

the client she was not joining in the exercise she only sitting and watching

because she was easily fatigue and had difficulty of breathing whenever doing a

long movement. But if she can do some exercise while sitting she was

performing it. This activity makes her relaxed and happy because she was able

to join with other people with her age group.

IX. TREATMENT

The goals of asthma treatment are to:

 Prevent chronic asthma symptoms and asthma attacks during the day and night

 Maintain normal activity levels, including exercise and other physical activities.

 Have normal or near-normal lung function.

 Be satisfied with the asthma care received.

 Have no or the least side effects while getting the best medications.

Treating asthma in the elderly is complicated due to interactions among effects of aging,

asthma and coexisting conditions.

 Normal aging-associated changes in lung structure are likely to exaggerate

asthma symptoms. These changes sometimes make it difficult to distinguish

clearly between asthma and COPD, especially in patients who have smoked.
  Patients with COPD often have a reversible component to their condition, and

asthma medications may relieve some symptoms and improve the patient's

quality of life.

 Elderly patients may have a decreased response to influenza immunization as

well as to pneumococcal vaccine and tetanus toxoid.

 Patient education and asthma management plans for elderly patients should take

into consideration possible decreased ability to handle multiple complex stimuli,

memory problems, loss of coordination and muscle strength that make it difficult

to use metered-dose inhalers, hearing and visual difficulties, sleep disturbances

that may impair cognitive function, and depression.

 Adverse asthma reactions from medications related to polypharmacy are greater

in the elderly. It is important to ask what other medications the elderly patient with

asthma is taking. Particularly hazardous are beta-adrenergic blocking agents

(even ophthalmic preparations) and, in some patients, non-steroidal anti-

inflammatory drugs and antidepressants.

Non-asthma Medications with Increased Potential for Adverse Effects in the

Elderly Patient with Asthma
Comorbid
Conditions For
Medication Adverse Effect Comment
Which Drug is
Prescribed
Worsening Asthma
Hypertension
Beta-  bronchospasm Avoid where possible;
Heart Disease
adrenergic  Decreased when must be used,
blocking response use a highly beta-
Tremor
agent to bronchodilator selective drug
Glaucoma

Nonsteroidal Arthritis Not all elderly with

Worsening asthma
anti- Musculoskeletal asthma have
inflammatory diseases  bronchospasm nontolerance
drugs of NSAIDs, but are best
avoided if possible
Additive effect with
antiasthma medications
that also produce
Non- potassium loss
Hypertension Worsening cardiac
potassium- (steroids, beta-agonist);
Congestive heart function/ dysrhythmias due
sparing elderly also more likely
failure to hypokalemia
diuretics to be receiving drugs
(e.g., digitalis) where
hypokalemia is of
increased concern
Also note that some
over- the-counter
asthma medications
Cholinergic Urinary retention Bronchospasm
contain ephedrine,
agents Glaucoma Bronchorrhea
which could aggravate
urinary retention,
glaucoma
ACE Heart failure Increased incidence of
inhibitors Hypertension cough

Management of Asthma in Older People

 All patients need to have regular visits scheduled for their asthma. Older people

need to have a written Asthma Action Plan that tells them exactly what to do to

prevent and treat asthma symptoms. The plan should be in large print, if

necessary, and reviewed at each office visit.

 Elderly patients may need assistance in order to keep their asthma under control.

They may have difficulty with transportation, prescription costs or emotional

stress.

 Desired therapeutic and clinical outcomes may be more difficult to achieve in

elderly patients with asthma. Normal lung function may either be unattainable or

be attainable only with potentially dangerous, high pharmacologic doses. It is

 important, therefore, to set realistic goals for therapy. Treatment goals may need

to be modified to maintain a desirable quality of life.

 Because compliance with multiple therapies – for both asthma and coexisting

diseases and conditions – may be difficult, elderly patients often need special

education and training in using asthma medications and devices.

 The potential for drug interactions is greater in elderly patients with asthma

because these patients are likely to be on multiple medications for other

conditions, particularly heart disease.

o Beta2-agonists and theophylline use should be monitored carefully

because they can cause tachy-arrhythmias and aggravate ischemic heart

disease.

o If theophylline is used, it should be used with caution, especially in

patients with congestive heart failure.

o Systemic corticosteroids may aggravate congestive heart failure, lower

serum potassium with potentially adverse cardiac effects or, in diabetics,

increase blood sugar levels.

o Corticosteroids in high doses may reduce bone mineral content and may

accelerate development of osteoporosis.

 The usefulness of PEF monitoring may be limited by age-related factors that

compromise the effort and perceptual and motor skills required for accurate

measurements.
 Avoidance of environmental triggers, including tobacco smoke and other airborne

irritants to which the patient is sensitive, is useful for many elderly patients with

asthma.

 It is important that physicians have a regular follow-up visit with their patients with

asthma. This should be done at least yearly. The following chart provides the

basic elements of a follow-up visit for asthma with a doctor or asthma educator.

 A critical element to managing asthma is education:

1. Assess the needs of your patient

2. Set mutually-developed objectives

3. Try to work out any barriers that stand in the patient's way

4. Create a relaxed, learner-friendly environment

5. Try different styles of delivery of the educational material

6. Assess how well the patient is learning/understanding the material

7. Refer to formal asthma education programs in the community

 VISION MISSION
A premier university in historic Cavite State University shall provide
Cavite recognized for excellence in Republic of the Philippines excellent, equitable and relevant
the development of morally upright educational opportunities in the arts,
and globally competitive individuals. CAVITE STATE UNIVERSITY science and technology through quality
Don Severino Delas Alas Campus instruction and relevant research and
development activities. It shall produce
Indang, Cavite professional, skilled and morally upright
individuals for global competitiveness.

College of Nursing

A Case Analysis
Gerontology: Asthma

Submitted by:

Jinkee G. Bacsa

Fatima Mae A. Garcia

April Lynne A. Rocas

BSN 4-1

Submitted to:

Mary Antoniette D. Viray RN, MAN

December 6, 2017