Asthma

Nursing Diagnosis & Interventions for Asthma- Student Guide

Introduction

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma symptoms can range from mild to life-threatening, depending on how often you have asthma attacks, what triggers them, and your reaction to the triggers. Treatment for asthma includes medications (such as inhaled corticosteroids) and other therapies (such as bronchodilators). 

This post will focus on diagnosis, care plans, and interventions for asthma which are essential in managing this condition. It is recommended that medical practitioners read through this blog post for an overview of treatment approaches to understand more about their patients with asthma. However, if you’re a nursing student and are stuck with your nursing assignment, our nursing writers are ready to help. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is Asthma?

Asthma (also known as the airways disease) is a chronic lung disease that inflames and narrows the airways. Asthma causes breathing difficulties, breath sounds (wheezing), coughing, chest tightness, or pain when inhaling deeply. Asthma can cause severe breathing problems that can be life-threatening. 

About 25 million people in America have asthma. 80% of them are adults, and 20% children.

Who is at Risk for Asthma?

Anyone can develop asthma; even children as young as two years old can get it. However, black people are about three times more likely to develop asthma than white people.

What Are the Risk Factors of Asthma?

Some factors that may increase your risk for developing asthma are:

– Family history of asthma 

– Living in cities with high pollution levels or factories/power plants close by  

– Having a respiratory illness like pneumonia or bronchitis during childhood 

Allergies – when you are exposed to indoor or outdoor allergens, you may develop asthma signs. If you have a pet, you should vacuum at least once every day to reduce the amount of dust and dander in your home. Wash laundry with cool water and use HEPA filters on ceiling fans and air purifiers where needed.

Asthma triggers – you are more likely to have asthma attacks when exposed to specific triggers, including grass, trees, weeds, or molds; animals like cats and dogs; cockroaches; dust mites; strong smells from cleaning agents, paints, or perfumes.

Asthma can occur in people of any age, but the signs usually begin before age five. Children are more likely to get asthma than adults. 

Smoking – smokers are more likely to develop asthma than non-smokers. Inhaling second-hand smoke around you can increase your risk of getting asthma. People who quit smoking reduce their risk of developing asthma and having attacks because they already have it.  

Chronic sinusitis – chronic (long-lasting) sinus infections can irritate the airways in your lungs and cause inflammation. 

Obesity – being overweight or obese may increase your risk for asthma and prevent you from losing excess weight. Obese people are more likely to have severe attacks, often need to use their reliever inhalers, and are less likely to respond well to treatment. So if you’re overweight – lose the extra weight! 

Restricted airways – people who have had a lung transplant or have cystic fibrosis may be at increased risk of developing asthma. 

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How Can You Prevent an Asthma Attack?

To prevent an asthma attack, you need to learn what triggers your attacks and take action to avoid them. 

1) Avoid/quit smoking.

2) Wash laundry with cool water.

3) Use air-cleaning devices to filter allergens like dust and dander and particles out of the air in your home.

4) Vacuum at least once every day to reduce dust mites, cockroaches, and animal dander.

5) If you have a pet, wash bedding once weekly in hot water.

6) Use a filter on ceiling fans and air purifiers where needed to remove particles from the air.

7) Avoid pollen triggers by scheduling activities indoors during high-pollen times (morning and early evening) when plants produce pollen or take an antihistamine 30 minutes before going outside.

8) Know which medications can trigger an asthma attack and use them only as prescribed.

9) Use your reliever inhaler the moment you think you are having signs of an asthma attack.

10) Stay hydrated by drinking plenty of water, especially during exercise or in hot weather – heat can trigger attacks.

11) If you have severe asthma, carry a quick-relief inhaler with you at all times and use it as soon as signs develop.

12) Avoid quick fixes like over-the-counter drugs, cold remedies, or steroids to prevent an asthma attack because they can worsen your symptoms instead of making them better.

Asthma is not just about having attacks – but also being able to lead an everyday life.

It’s essential to learn how you can prevent asthma attacks and live a regular life!    

What Are the Causes for Asthma?

Causative Factors include;

1) Trigger from allergens such as pollen or pet dander

2) Medications

3) Smoking

4) Food allergies 

5) Exercise

6) Poor sleep

7) Stress

8) Environmental pollution such as dust mites, cockroaches, smoke from cigarettes, and wood-burning stoves

9) Family history

10) Physical contact with an allergen

11) Pregnant women

12) Lack of oxygen during the delivery process                

13) Hormonal imbalance

14) Cold weather or dry indoor heaters during winter months

Classification of Asthma

There are two types of asthma: allergic asthma, which includes symptoms like sneezing/coughing/itchy throat with mucus production (asthma with rhinitis), and non-allergic asthma, which triggers symptoms like wheezing/coughing without mucus production (asthma with no rhinitis).

Asthma is also classified based on how severe the symptoms are: mild intermittent, mild persistent, moderate persistent, severe persistent, and very severe. 

Asthma is not just one disease. The symptoms may occur in various combinations depending on the person and the triggers of the attacks.

What Are the Signs and Symptoms of Mild and Moderate Intermittent Asthma?

Asthma symptoms can range from mild to life-threatening, depending on how often you have asthma attacks, what triggers them, and your reaction to the triggers. 

Mild symptoms include coughing, wheezing, breath sounds, difficulty breathing, absence of dyspnea, and no need to use the reliever inhaler. 

Moderate symptoms include coughing, wheezing, difficulty in breathing with small amounts of sputum (clear or yellowish mucus).      

Signs of severe asthma are coughing, dyspnea, wheezing, blue or gray lips with feeling like you are not getting enough air in your lungs. You may also have chest tightness, trouble breathing even lying down, and an inability to speak or walk.  

What Are the Signs and Symptoms of Severe, Very Severe Asthma?

Severe signs and symptoms include rapid and labored breathing, anxiety, or restlessness, leading to panic attacks. You also may have a hoarse voice from excessive mucus production, cough with frothy sputum (phlegm), dyspnea with wheezing even during rest, and increased heart rate and blood pressure.  

Signs and Symptoms of very severe signs include:

– Difficulty in speaking or walking and feeling very tired,

-Dyspnea while talking  

– Blue lips/fingertips   

– Prolonged expiration

-Breath sounds that do not evident with a peak flow meter

Chest pain that may radiate to your back or neck area   

– Feeling lightheaded or fainting   

– Needing more than one puff of the reliever inhaler immediately after taking it (horrible sign)  

What is the Nursing Diagnosis of Asthma?

Nursing Diagnosis: Airway Clearance Disorder – Acute and Chronic

Defining Characteristics:

Lack of airway obstruction because the respiratory passages that carry air to and from the lungs are open. However, there may be a productive cough (with sputum production) or wheezing while breathing.  This indicates a respiratory infection in progress. 

Breathing is labored – rapid breathing is common with asthma, and it may not get enough oxygen to the body tissues.  

Nursing diagnosis of asthma: Impaired gas exchange related to effects of bronchoconstriction and cellular infiltration. It is caused by thick, sticky mucus that can plug up the airways. Impaired gas exchange is the primary problem, and it causes all the other issues.

Nursing Diagnosis:  Imbalanced Nutrition; Less Than Body Requirements (related to increased metabolic needs due to ongoing physiologic process)

Impaired Skin Integrity: related to retention of sputum, thick or excessive mucus

Nursing Diagnosis: Alteration in Breathing Pattern (ineffective breathing pattern related to severe dyspnea with acute exacerbations) Caused by Asthma Attack

Diarrhea is a common complication of asthma and can interfere with proper nutrition.  If you have diarrhea, drink lots of fluids and eat extra foods with many calories but are easy to digest, like bananas, rice, or pasta.

Asthma Symptoms diagnosis: Allergic reaction or asthma attack usually begins with a series of symptoms including; 

1) Rapid, shallow breathing 

2) Labored breathing (trouble filling your lungs with air)

3) Wheezing or breath sounds as breath is exhaled     

4) Cough (usually dry at first, but may later produce some sputum)

5) Tightness in the chest/back area.

6) Chest tightness/pain

7) Anxiety/panic attacks

8) Fatigue (because of lack of oxygen to the body tissues) 

9) Loss of consciousness or fainting (rare, but possible because your brain is not getting enough oxygen either.)   

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How Do You Test for Asthma?

There are many ways to test asthma, but the most accurate way is with spirometry or peak flow. Spirometry assesses how much air is inhaled and exhaled in a specific amount of time, while peak flow monitors lung function by measuring the speed at which air leaves your lungs during a forced breath. The two methods work together to provide information about how well your lungs are functioning and can be used as part of an overall treatment plan for asthma. 

To accurately monitor lung function with either method, you must follow all instructions carefully and use your best effort when taking the measurement.

Spirometry or peak flow will help identify asthma because it measures how well you can move air through your lungs by measuring the volume (taken in milliliters) and the speed with which you exhale (loudly or quietly).  There are many reasons for wheezing that may not be related to asthma, so if your doctor suspects asthma, they will need more tests such as a lung function test called spirometry or peak flow test.

Spirometry measures the amount of air you can exhale in one second, while peak flow measurement records how much air you can blow out in one breath. Peak flow readings are typically assessed by blowing into an asthma-management device called a peak flow meter which usually displays your reading as millimeters of mercury (mm Hg). The higher the number on the meter reading, the better your airflow is likely to be.

What Are the Intervention Rationales for a Patient in Severe Acute Asthma (Status Asthmaticus)?

Continue oxygen administration and maintain ventilatory support. The nurse can monitor the level of respiratory distress by continuously monitoring the patient’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximetry becomes unstable and the patient’s respiratory rate is above 30 breaths per minute, and the capillary refill time is less than 2 seconds, a clinician should be notified immediately.

The Interventions Rationale for a patient in severe acute asthma with severe dyspnea

Continually administer oxygen by mask at 15 L/min. This will increase PaO2 levels and decrease the likelihood of infection. The nurse should also frequently check the patient’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

The Interventions Rationale for a client in severe acute asthma with altered mental status

Continuously record the client for changes in respiratory rate, color, and depth of respiration. If the pulse oximeter reading becomes unstable, if there are significant changes in skin color (greyish hue) or significant changes in breathing patterns, a clinician should be notified immediately.

The Nursing intervention for a patient in severe acute asthma with nausea or vomiting

Place an antiemetic agent (e.g., ondansetron) administered via the patient’s IV. This will decrease the likelihood of vomiting and help relieve anxiety caused by dyspnea. The nurse should also frequently record the patient’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

Interventions Rationale for a patient in severe acute asthma with increased work of breathing

Assist the client with his coughing efforts by gently tapping him on the back, raising his head during expiration, and instructing him to take slow deep breaths. If the client develops a cough, the nurse can administer an antitussive via the IV to help ease breathing efforts. The nurse also should frequently check the client’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

The priority nursing intervention for a client suffering from asthma exacerbation

Educate the client about the importance of avoiding triggers, increasing his use of inhaled medications, and using his peak flow meter daily. Educating a patient with asthma can help him prevent future episodes by keeping track of his responses to triggers that may have triggered his asthma. Step-by-step instructions should be provided to the client to correctly use his peak flow meter and what he needs to do if his reading is less than 100%. The nurse also should frequently check the patient’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

The priority nursing interventions for a client in status asthmaticus with chest pain that radiates to his back or down his arm:

Administer an analgesic such as ibuprofen or acetaminophen through the IV as ordered. This will decrease the client’s discomfort and help him relax. The nurse should also frequently check and record the client’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time.

Interventions Rationale for a client in status asthmaticus with chest pain that is not relieved by traditional analgesics:

Obtain an EKG and the report from the stretcher nurse, as well as a complete set of vital signs. The client should be placed on telemetry monitoring. His blood pressure should remain within normal limits (this may require the use of a vasoconstrictor such as phenylephrine).

The priority nursing interventions for a client in status asthmaticus with dyspnea and elevated heart rate:

Assist the client by gently tapping him on the back, raising his head during expiration, and instructing him to take slow deep breaths. The nurse also should frequently check and record the patient’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

Nursing interventions for a client in status asthmaticus with tachycardia that stems from his underlying heart disease and anxiety regarding his underlying asthma:

Educate the client about breathing techniques, monitor his vital signs, and implement the immediate interventions listed above. Because he is likely to be anxious, it will be necessary for the nurse to maintain a calm demeanor and keep him informed of his status regarding treatment measures or procedures that are being initiated. The nurse also should frequently monitor the patient’s pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

Asthma Nursing Care Plans

A comprehensive nursing care plan for managing asthma incorporates client education, environmental control, and medication management. Environmental factors such as air quality and temperature can impact respiratory health. Medications should be tailored to the individual needs of each client in conjunction with their physician’s recommendations. The ultimate goal is to reduce the frequency and severity of exacerbations while improving the overall quality of life-related to asthma management.

Asthma nursing care plan for a client with severe acute asthma:

1) Call the respiratory therapist or physician immediately for additional medication or other interventions that may be needed.

2) Assess the patient’s peak expiratory flow rate (PEFR). If PEFR is less than 50% of the standard value, get a spacer and administer Albuterol 2.5 mg every 12 hours by nebulizer through the spacer.

3) Use a peak flow meter to assess the patient’s rate of airflow. If this value is less than 50% normal, get a spacer and administer Albuterol 2.5 mg every 12 hours by nebulizer through the spacer.

4) Record all vital signs frequently (every 5 minutes). If the patient’s systolic blood pressure or heart rate exceeds 140, notify the physician immediately.

5) Record all peak expiratory flow rates (PEFR) every hour and compare them to previous values. Determine if a change in medication is needed by comparing PEFRs with those of other occasions when the patient was at home.

6) Record the patient’s respiratory rate every 15 minutes. If the respiratory rate is 30 or greater, notify the physician immediately.

All patients with severe acute asthma should be on telemetry monitoring if possible.

Asthma nursing care plans for a patient with Intermittent Asthma are:

1) Emphasize symptoms of abdominal discomfort and pain with dyspnea, and have the patient notify you if these increase.

2) Monitor respiratory status closely by observing cyanosis, respiratory distress, shallow rapid respirations, orthopnea, and paroxysmal nocturnal dyspnea.

3) Administer Albuterol 2.5 mg every 12 hours by nebulizer through the spacer. The patient should take deep breaths using short puffs of air from their inhaler through pursed lips. 

4) Perform peak flow monitoring at home, and have the patient record his results daily. If PEFR is less than 50% of standard value or greater than 80%, notify the physician.

5) Encourage deep breathing and coughing exercises

6) Have the client maintain a symptom diary and report all respiratory complaints about the review with pharmacologic management.

7) Assess the appropriateness of his home environment, paying particular attention to the use of humidifiers and smoking, and educate him regarding these factors as well as medication.

The priority Asthma nursing care plan for a client with stable, poorly controlled asthma:

1) Review all environmental exposures that may irritate or aggravate asthma, such as cold air drafts from windows, allergens, cigarette smoke, high pollen count, and pets.

2) Have the client use a peak flow meter daily to monitor his rate of airflow.

3) Use a spacer when administering medications for the treatment of asthma or have the patient take deep breaths using short puffs of air from their inhaler through pursed lips. 

4) Encourage deep breathing

5) Educate client regarding the importance of good nutrition in maintaining overall health and wellness and its effect on asthma symptoms.

6) Assess the patient’s current health care provider and medication regimen, including dosage schedule, to determine if changes are needed.

Asthma nursing care plan for a client with stable well-controlled asthma:

1) Review all environmental exposures that may irritate or aggravate asthma, such as cold air drafts from windows, allergens, cigarette smoke, high pollen count, and pets.

2) Have the client use a peak flow meter daily to monitor his rate of airflow.

3) Use a spacer when administering medications for the treatment of asthma or have the patient take deep breaths using short puffs of air from their inhaler through pursed lips. 

4) Educate patients regarding the importance of good nutrition in maintaining overall health and wellness and its effect on asthma symptoms.

5) Assess the patient’s current health care provider and medication regimen, including dosage schedule, to determine if changes are needed.

Asthma nursing care plan for a client in Status Asthmaticus:

1) Maintain patent airway, frequently assess for change in mental status.

2) Administer Albuterol 2.5mg every 12 hours by nebulizer through a spacer. If wheezing persists, administer Albuterol every 5 minutes by nebulizer with the client sitting position on bed rest.

3) Administer oxygen by nasal cannula at 8-10L/min or via facemask at 15L/ min.

4) Place an IV and infuse fluids at a rate of 50mL/kg/hr.

5) If the client is hypotensive, administer IV epinephrine 0.1 to 0.5 mcg/kg every 5 minutes as needed for systolic BP less than 90mmHg or diastolic less than 60mmHg.

6) Administer Diphenhydramine HCl every 4 to 6 hours PRN.

7) Consider IV magnesium sulfate with at least two additional drugs if significant tachycardia persists despite other interventions or if hypotension is present.

8. Auscultate breath sounds every 4 hours and reports dyspnea, rales, or crackles to a physician.

9) Assess vital signs hourly for changes and notify the physician if necessary.

Asthma nursing care plan for Hypotensive patient in a severe attack

Administer oxygen by mask at 10L/min and prepare for intubation. Reassess the patient every 30 minutes until unstable vitals are stable.

Administer IV epinephrine 0.1 mcg/kg every 5 minutes as needed for systolic BP less than 90mmHg or diastolic less than 60 mmHg.

Administer Albuterol 2.5mg every 12 hours by nebulizer through a spacer. If wheezing persists, administer Albuterol every 5 minutes by nebulizer with the patient sitting position on bed rest.

Apply supplemental oxygen at 8L/min via nasal cannula and give IV fluids at a rate of 50mL/kg/hr.

Administer Diphenhydramine HCl every 4 to 6 hours PRN.

Administer IV magnesium sulfate with at least two additional drugs if significant tachycardia persists despite other interventions or if hypotension is present.

Care plans- Hypotensive patient in severe asthma

Administer oxygen by mask at 10L/min and prepare for intubation. Reassess the patient every 30 minutes until unstable vitals are stable.

Administer IV epinephrine 0.1 mcg/kg every 5 minutes as needed for systolic BP less than 90mmHg or diastolic less than 60 mmHg.

Administer Albuterol 2.5mg every 12 hours by nebulizer through a spacer. If wheezing persists, administer Albuterol every 5 minutes by nebulizer with the patient sitting position on bed rest.

Administer IV fluids at 50mL/kg/hr.

Place an indwelling urinary catheter and infuse fluids at a rate of 50mL/kg/hr.

Administer IV magnesium sulfate with at least two additional drugs if significant tachycardia persists despite other interventions or if hypotension is present. Administer diphenhydramine HCl every 4 to 6 hours PRN.

Add 3mg/kg IV over 30 minutes followed by 1-2mg/kg q30m until improvement in respiratory status is noticed. If not contraindicated, consider administering a nebulizer of Albuterol 0.083% 20mg diluted in 2L of salbutamol 1% every hour until improvement in respiratory status is noticed.

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Complications of Asthma

Asthma may lead to life-threatening conditions such as pulmonary edema, acute respiratory distress syndrome (ARDS), and pneumothorax. Some other possible complications include pneumonia, COPD, sleep apnea, heart failure, or arrhythmia.

1. Pulmonary Edema

Pulmonary edema is a life-threatening complication of asthma that occurs when the tiny air sacs of the lung, called alveoli, fill with fluid. When this happens, oxygen exchange in the lungs is impaired, and breathing becomes more difficult. Symptoms include difficulty breathing or dyspnea, chest pain, fatigue, rapid heartbeat (tachycardia), and a cough that produces frothy, pink-tinged sputum. Severe edema involves increased swelling of the alveoli, which can result in their rupture and leak large amounts of fluid into the lungs.

2. Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is a life-threatening condition that occurs when fluids leak out of the blood vessels into the lungs. In ARDS, there’s widespread inflammation in your lungs’ air sacs, called alveoli, and impairment in gas exchange.

3. Pneumothorax

Pneumothorax is an uncommon but dangerous complication of asthma. Pneumothorax occurs when air gets into the space surrounding one or both lungs. The air puts pressure on the lung, which makes it harder to breathe. If a pneumothorax is acute — that is, if it happened suddenly — you may develop life-threatening changes in your blood gases and have symptoms of shock, including rapid breathing and rapid heartbeat.

Treatment for Asthma     

If you’re diagnosed with asthma, your doctor will recommend a treatment plan that’s tailored to your needs. The goal is to reduce and prevent inflammation of the airways in your lungs. In addition to avoiding triggers, regular use of an inhaler at home is essential to help control your symptoms.

Asthma Medications

Asthma medications are broken into three categories: quick-relief, long-term control, and rescue medications.

Quick Relief Medication – Albuterol

Here are the common ones;

Albuterol (ProAir, Ventolin): Used to treat acute symptoms such as ­wheezing, tightness in the chest, coughing, or dyspnea, it comes in tablet form, as an inhaler and nebulizer.

Throat sprays (Sudafed): Antihistamine medication that can help to relieve the itching and swelling of the throat.  It also comes in tablet form and is also used for colds or allergies.

Leukotriene (Accolate, Singulair): This is a type of medicine that neutralizes the effects of leukotrienes. Leukotriene is a natural substance in your body that causes an allergic reaction.  

CLOPIDOGREL (Plavix): This oral antiplatelet drug inhibits ADP-induced aggregation and platelet activation and may reduce the frequency of asthma attacks.

Asthma Medicine for Children  ALBUTEROL SULFATE (ProAir, Ventolin): For inhalation aerosol only.

CORTICOSTEROIDS: (Azmacort, Pulmicort) an inhalation for around-the-clock asthma control in patients 12 years and older. This medicine can cause weight gain and is not recommended in patients with pre-existing obesity or a family history of this syndrome. Inhaled steroids are not recommended for use in children less than 12 years of age.

Long Term Control Medication – Anti-Inflammatory Drugs (Leukotriene Modifiers)

Long-term control medications are recommended for patients with persistent asthma. These drugs reduce inflammation in the airways, keeping your lungs open and reducing asthma symptoms.

Example: Salmeterol and Fluticasone (Seretide Evohaler): It helps open lung airways and helps relieve breathing problems by reducing inflammation in the lungs.

Anti-inflammatory drugs include inhaled steroids or leukotriene modifiers such as Singulair.

Rescue Medication

Asthma can attack fast, without warning, but you can fight back fast with rescue inhalers. Rescue medications such as Albuterol open the airways and help to relieve asthma symptoms quickly. You’ll usually need a quick reliever for sudden-onset symptoms that are not controlled by your regular asthma medication and another medication (such as Singulair) for ongoing maintenance treatment.

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Summary

As mentioned above, the common causes of asthma include allergies, pollution, irritants in the air or food, and other factors. Asthma is an auto-immune disease that occurs due to inflammation of the airways. The treatment includes anti-allergic drugs like steroid medications along with specific allergens for allergy-related asthma.

Asthma can be prevented by minimizing smoking and avoiding pollution. We should wash our hands properly before eating delicious food. If someone in your home has asthma, then be cautious, especially during the winter season, and try to keep the area of the house clean from dust. Try to avoid cold air, hot air, and wet clothes at night time. In addition, you can also use a machine which can filter small dust particles from the air.

If you feel difficulty in breathing, then don’t forget to take your reliever medicine along with a reliever machine, which we all must have at home.

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