CASE REPORT: COMBINED PURSED-LIP BREATHING AND CHEST CLAPPING FOR INEFFECTIVE AIRWAY CLEARANCE DURING ACUTE ASTHMA EXACERBATION
Keywords:
case report, clinical reasoning, diagnosis, management, outcome, asthma attack, ineffective airway clearanceAbstract
Background: Asthma is a chronic inflammatory airway disease characterized by reversible airway obstruction and bronchial hyperresponsiveness. During an asthma attack, bronchoconstriction and mucus accumulation may impair ventilation and cause ineffective airway clearance. Non-pharmacological nursing interventions such as Pursed Lips Breathing (PLB) and chest clapping may improve respiratory status; however, evidence regarding their combined application in asthma attack patients remains limited. Case Summary: This case report describes a hospitalized female patient with an asthma attack presenting with dyspnea, increased respiratory effort, ineffective airway clearance, and secretion accumulation. Clinical findings included accessory respiratory muscle use, reduced breathing depth, and decreased oxygen saturation. Investigation and Diagnosis: Diagnostic assessment included physical examination, spirometry, blood gas analysis (BGA), and pulse oximetry. Initial findings showed FEV1 34.82% (0.72 L), PaCO₂ 63.1 mmHg, pH 7.18, and SpO₂ 84% without oxygen support, indicating respiratory acidosis and impaired respiratory function. The nursing diagnosis established was ineffective airway clearance related to excessive secretions and airway obstruction secondary to asthma attack. Management: Nursing care was provided based on Indonesian Nursing Intervention Standards (SIKI) Respiratory Monitoring (I.01014) combined with PLB and chest clapping for three consecutive days, three times daily, including respiratory monitoring, secretion management, education, and breathing exercises. Outcome: Clinical improvement was observed after intervention. FEV1 increased to 52.25% (1.65 L), PaCO₂ decreased to 44.56 mmHg, pH improved to 7.36, and SpO₂ increased to 98%. Dyspnea and accessory muscle use decreased, while breathing depth improved. Conclusion: The combination of PLB and chest clapping may support airway clearance and improve respiratory status in patients experiencing an asthma attack.
