IAIAp{ a{tull5VRoufl ttilo 1:ofi lJ:3$tuufl n0

A , Lqzto o r o v 2) 'r fr o usi I ffqJ rid r : r si r un ri E cir n Yu {rl fr ffi ,.r r u fi fi il : v fi u n r : oi

rilnnri{il:vrnn#aulrJ

drrrHriw'ruluraasrfrvr o r (drunr:nurura)

t*uud,urrotr?rj:vrfiuidr o a jt

I . p{ a il'l u yt tlj u p{ a n 1 : r{ r tu u.1 t u yt p.t 1 il il 1

4- y o r u t y, jrio.r o'q fi r r r p.i u l{u u.r u r ril : n ? r ru f, n r : q ua fl u ro { fi q n do'.r lu {rJ r u I: n H o u ff er

z:t util8u?Iau

rflilolos

u]ilflila?:T€u yllainulolad

9t 1tt14 U'1 Tt tjl U 1A ?ffi Slt 5

.o t j(sl'trr?1u{[a1il :v{n . 492)

tlhfl nr:ilrJt1I'ln I:{y{ urura nat.r

drrinnr:lr?rwt

i 9)tt s 4 d vt:o{ nlT?IUlljtnp{il?U t:nff Oil?rqlquuilnuq,

-9,,44.!Av2. { o tdu o t tu ? n q ? t R r : tn o n ar u r {n u n?o rl ir rJ t { { r u ld'fr rJ : s fi vr fi n r n ru r n zu3uq

ddl o a dtt{a{ tuntiluru oR't :9t ltul{inullr.t'tutJt

, Cl ,tt s' 4 4 vl. TO9{0{rU f'l l:V,lU]U] n fdil ?U t: nH OU?lq tA UUil n U

i" a2. :susr?atfirirrfiunr: to 5u (iufi 16 y{quntnil 2553 _5ufr zs ytqunrail 2553)

3. fl ?riliJr1$nnr:?r€euuafi niilflunt:{ilfi ilnt:g

3.t narrucirdaruorl:nroufiert

"a at s !o - Z u o6re ln r A

t : fl H o U H 9l t1J u t : fi m il n I ; o n [dU tto 5.1 I o { H n o q n il yt r lf H n o q n il "[ ? gt o d-{

I a t o A + Y s < o q 9/tu d vrn:v{uFoilnd rfroroodlfl:vduilnoen:J0eHqd'?dun{ vrrh{rfrJaufiolnt:'lo flou fiiul0n,Aodd,t,,"[ri6ru rrasvr€r1ofitfru{ifl (wheeze) drornr:rnrirfirv6duror fi?o]qunr:;flH'r J:nmol#srdt s i , 4 ua a^ 3 "triluJ:flfiwuriou unvfrqrifrnr:airfrrufiufr'rlan :J:yryrg'[mavrrqrTn^nr:ni to.r]:sr?roilffeds

ddr0 - 12 vo lurfin ttae 6.e x lu{lrqj l:srrorfipr,flulru,fu;ufifirlnn:syrueiefrrJ'rut 9t o t g,tt I 4 t j h Irioudrsqr otnnr:xir:?tnu'jr{rJruJ:nruorfrpr ilrfln'jrnT-: "[rjarrur:nfirnnn::ru'ldrqiu

nurlnfi frrjrfl J:fl fi o ufrq zt.t x frsdo{r{rirnr:fnur droornr:nuuru,,rud#orqnrfiuqqq

t I A J" i<,i,oeirlriounfrsflis"[u:s€Jvr?nruu-nTJfip.irurur uae 14.8 x dosr{rfininur6"l1u]:{ylutura

na'lnnr:16orl:n

6'n u iu s fi xir ri'q1 r o r 1 : n m o il ?r^fl fi o n r : fi fi u a o e n ru'h si o fr r n : c aiu fi e il n 6 J n eJ

gJtt s 4 v t j 4 9J t , A dHAOqAilIO{ryil?U t:nilOUl49tSvflnfl',l{ttjrilot0od{n:s6u9t1.1 6l r,f,u nauqu n,l-t}JtEu

n s o o n "t n q ua y rfi o H a o n o lJ 14 q 6'r fi fl o u r n n'j r rJ n st^ri r l#fiil r u l : n fl o u fi e rfr q o r n r : H r el ov

drurnttavmrulofi rfi u{ierItlas4rdha

fla [na'l:rnq l:flr,roufi-qrrulrilu 2 nn"lflFto

t . n n'l nyr r.r 6ru ry Tu i vr u r rfl u n n 1 n fi fi dr rr E ru r 0 r n n : : ru fi'u f, u to 4 ru^r rv(

z. na'lnfi hitEivrr{6ruil Iu?r€rr tfl u pra o rn nr: ri r.: r u 1il alJ n a EJ o {

:y u u il : s dt vr d'sr Iu rjsr^ 6o :s u u 6ru y{ rrr 6'fl fi'u : s u I w r : rfi I w r rr 6'n

dnuarynrsn6fin

I : n r'r o u fr q rfl u l: n fi n r'ldlu 4 n rw a 4 n 5u r ui eiru ru r n :in o y r?ru fi o r n i : d.r r rpi

dsadrn'jdr-j16n ornr: r0{J:nHoufrnfro ornr:'[o rro1nhi6ru r.rrulofirfiurie rflu 1 fi'ru 1 d'nuarvvr

I

i?rri'cyro'r1:nrr,rou#erfro fnovfiornr:ilrnlur?nlfla1{fiu :Lrrnfr{rJruI:nuorfrqororsfiIUl A @ d t d s, h rd dt^g)o]fl 'r: l0t:05 {rl tu{ou]{r9tu? [nu [:lruornr: u Oun

"16

A- - e)tt s 4 d iu ' o rr ^ , o- J i ;lu o { 0 1 n t{ il ? U I : n il 0 U 1{ 9t tJ fl n oq n ilfl t rn o al n : v q u p'io il n gr Ft I u u n n r fr t o o d.t

I a ia t v a A in : y du o s rfr q o r n r : fi G u n'j r 6'u ff q fi r ff n : v {u 1 fi'frrl r o r o u 1 duri

t. ct:qru^rr# fidld'rg16"rri 1:{u rna:non'l# uila{dlll :r iruncrosq#rrravI

. A 9 r 4 o q 9/a t , r 4 A llrt A y[[]J? d'l:Q:Jtt?Ilfia1uvl1tfl[nqo1n1:fi0Utlluyl'l{ rype t hypersensitivity nnrrrioltioflil?Uylt[{

dt:flfittfrdnqilto'ld1:qlru^rrfrr{r'hJ at:4firrr{tvfi'rriu tgE lJurrrucrrcrad'(mast cells) rfirt#rfierq${g

flr:ud{dr:fi'ndrnr:dnrdil r'tiu 6nsrrfiu(tristamine) rrrof6lnfiil(bradykinin) qInlor:6u

(leukotrienes) }J:anrtrnaufiud (prostaglandins) trnr n:oilfilttryu [o T (thromboxane A2)i o o ta d d I' afrsdrl?irnnfiaoqnilfril u?iltlasilnr:d'stoltfiofl (vascular congestion) fiGun'jr acute

: s h d u 4 odd Ju i o - a 4< aasthmatic response uonotnfi q1nrln:6u et{ilqrrer{tsanontdil fidrni'igffo dlofiluflnd

tttt9,

(eosinophils) rurqrurgruluua0nailfr.:nrnt#rfienr:d'nrarrfi:rdu finarru'hro{?rnoanrurfiruduarA-Jau

ltnstfrqnl59ro1Jduo{don'l?s}ioufrnR1sHfr{ (late asthmatic response) d'rriunr:dlrfran'uar:

^ 9t o q 9)Ytt 9) s o q 9s 4 d : 3 r o

QtJtlv{u0nt1fl0v11l [Hryu?uljourln? u.:vr1tl.t t:Fr1{ou14FrtJo1fl]:11\uil1ntu9t?u [unr::nurS 4 4 o dt A : gt 4 i @ q o a 9.9)t : fl l't 0 u fi 9t 0 { n 1 til u il n g n o.1 fi n fl ta u { n'l : dxt t{dn u d] 5 R tJ t [y't a ? u

2. nr: oondr fi'rnru r{rhi'frrjrul:nfi ou#qdru?uild{H ould nn lndnr: oonse y Y qe) A gt q .t y a o J" - Jfl1n{fl'lufl:squ [il1{oU 0slflU?1o{flUdilldUFl?'llJ:ou l't:odtuIdUut IuHn0nail Ft{u1]fl'l:e qu qjo

o u q j I d o o t ul 9r v o j 'oonfllo{fl]tJ tu11rr14.1 0tntflruu tvYn [1.1140u t9t{lun?1n1:00flfl'la{ntu luyt0tn]flou [[nyI

I,4 t o u t u v v a tdn?llJsug{ ttnnl:oonft'lann'l0nvsil{nunl:dilrud6t'r:8il[11r rnr:oonfi'ld'.rnret'hjdrb{rn^or

fl r : dn td u I o -: il a o e a ufr ru fi u na s'[ ri ri r l#n ?'l ru 1'] cJ o,1 fi a o q n il rfi ru fi u9-

3. n r : fr qtfi o m I{ r6u il I ul o riru r u rfl u ar n r q dr ri'tg fi d r h?J: nr n o u r?e ri rr?ur a o-.4-,tt----- r- - o 61 9,, tn r A gt A & h9 4d?uil1fl1fl9111nfl1:slgrlso t?:fl v'tu?t dlu'r:fiytl lfiflnoqa:J-hgtod{n:ygiuliltJilu "ldutuns

?6 diln1fi

4. ul ulfrdrricyfin:v{'ut#frrJrurou ldrrri aspirin beta-adrenergic antagonisr

ar:fiurfiu t.iu metabisulfite At{druot?{t: rdu tartrazine

5. fl ?r il rfl 6 fl er ri rlri'o rn r : l: n tr o u #n ra ?a {'ldAA Vs'

R1:?1{Oflgt:naa u S A I ua Ifl'l:?u0eu t:9tH0il149t o'1flufl1:ryflil:v?Ft 9l:?0:tilfilu ttasn:?rn-1,:

' IA UA

1.ro{1Jfl1rnn1:

I 6lJ:v?sr

n r :ifr o #u I : n n o u ff o ri r u 1r qj aur r : srifr r d'o ldler u sr ffs d : v ifi fr fi u', n.r trn o d4 d- * - <r !, c,,t 4 A y jo"[o mou r.rrulofirfrurifl frrosrflu 1 ?i'ru "l ur.rn:-{dil?uosdrJ"r:6ruonfisfrrn:r{ufivirhi'rfrer

l49o r 4 u tl jU ra d Aotfl t: "[6fqr0u tsu ilornr:fi a'{0'rnloor.]unsoo.r rrnrfi "[rifi o]n'l:fr ovtHfrounililnfima

a fl u €u y yt dlfituo n o u I { ?t u { lJ o { [ : n il o u l.t 9t rio nn :.t o rn 1 : [? n 1 na ]{ fr url: v nr:

99

urlnfl{rJruoroovfiornr:'lorfofr rfrurodrrrfrorfild lnurqy{ryodx6rornr:'lo r.rd'{rflu

l{fi5e rJ:v5fiJ:nafiud rl:sisr^nr:16rrJealun:ounfrfirflul:nno:Lffe fioyrirfld aa q s Aduljduunt:?u0q8 t:nuoil149t

I oa I aA I I

0 r fl il : e ? fl 0 s sl o n ? u 0 #u r t u n I : n il o et s et #u r$ o f.rq

(chronic obskuctive pulmonary disease) nl{tdufi'lultciruuuqerfru (upper airway obstruction)

ilnoqaillil{}'{o{ tlaunr?eil-?10diltflo? (congestive heart failure) fiorofiornr:iloutrdout s 4 hc,

fl atu t: fil.r o1r14ft t9l

nr:sr:?odr{nt8

f'n:st:?0dt{n'lelnv,t?u1unr:ifio#u ilonfl?uJtutr:{q,0,:l5n rras,i?ulun'l:AA s s ia e) v ^ -t:..Tfroii'urrunl:nfifiornr:ndrer 1 ri'ul:ernoufrsr'Id lurarvft{rJrflrird'sfiou nr:er:?0ir{nru

6ry ,t & r q o u hil. Y t e

nvvturtr:ldndtrurrjoEirulunr:rru1o (accessory muscle) fll'ld8urfieniet fi:Joflfr'{ z {r,rq jd o "1 J ,alu:rufiriluroufrodulut[:{srq[lertern or0sr:?oyru'jrfrqilnsr^ro{yr:?{ofl,[d odr.:1:fi6dr

fr:J r u ki fi o rfl r : u o il fr n fl r : er : ? 0 i r { n r ufi o v ki il il fi .r fi pr rJ n sr^r n u

Y lae^ j t v aa vR] : 9t : ?O yt I { il O { lJ fl U 9t n I : n il v U ?t suu fl rlu nl : .il oqu

i q r, AA - i r 4 a u r d J on r : vt o v I f n t : T fr t ii'o fr t tri u o u n- o n r : n : e o Eu du'i r fi n r : o n fi'u yt I { 16 u fi i u t r

r9

fifnurl#6du'ld' lqunr:l#urilutul'rooqnil Hioq:roilu'iruaennrL'hsiofirn:sdufiprrlnfi fraat[t l

3 ?fr tqrrnY-'Z/

1 . fl 1 5 a : I 0 n 1: q e riu vt r s r6u H r 0h (spirometry) rrtosr : r r m lj r fi n r : q or#ua6t4nr9/rdJ^q<a,'

vrl{reiu1't1ulttt3o"lru tiltuirilnr:oetfl'uylr,tretuilrulo frofrnir FEVl dtlras FEVl lpvc<t09 r qY s i, -- -,o& r a d% ttdrnouauo{qioflr:l#uriluruilnonoil }nufrnir pevt fifiururnneirer:J t2 % n?nrJt:oh?

u s 4 h9/fl l:?u0au [:nfi ou149t let

z. lun:fi fi 'hifi 41il1: fin:^ or o o sldrndorinnrrurS'rasaer or nrudrilroonqq

- io u d(peak flow meter) 6{fr:rnron Srrntrrur5rq{qato{ailfitrJrsen'ld'(peak expiratory flow rate,

PEFR) rir pBpR ovdtrfiofinr:qnt{uvrrsrpi^unruh tirrniuuirursfinoqailrr#,lrir psrn rdrunduq

r a daa u S 4 Vt9/tJ'Iflfl?ll9ru l5 % n?uoau l:flHoltmq 16

I

3. fl 1: ?gtfi?lu9'tu t't?ulj o{ft -l PEFRai a jqy* A - dln:o{tJoyl ts9to [n:0{?nn?lil15?

q{ qqt o{ a il lq ulfi'fril r uie ri r pern rdr rdu r rdrri r u rar ri tn ?'t?J r,iu r^t ?ugqq

3.2 a?rilflurdotnr:Ynul?t€Jn lag

A q9, IrlTo hil : : q tfl r m r t u r tu ?vr'r { lu n r : inu r I : n u o I fr or n ?i 0 v do { l#n r : vl u r u r n

v9lrrsAvrmri:nu'tp{u?u t:nu 0ul.t9t9 {st0 tt_Ju

:.2. t lr?n'r r ru furi fl:l rtr nn v cg r fi rfi ur fi'u J: n fi s u #fl ua s sr fnu r rfi o tri'rfi er

|4o-An?lil:?ulto tunr::flur d{flrniUnnr:rvcouryilrunsr-o aou1r4{ilrurdr1nir I:nilour?qrflus io - orn rn ai j y 4d - ilt:nililnl:ofllduilo{HaoqnxJ li][rraonnru-lr nLonuarn:sdurnoqnil0={6il d'sfu nr:

fnurl:fl il ou#q lil1dnr:fnurr noqail6u usirfl unr: fnu rfi non nil dnrar dsdo{1#rT nr

lunr: fnu tu ru url'iror n r: or o rs'hjfi u#rfi srrru drnr: fi ffrJ rur{rlorio.rl:n ld6 ny drut#Ytt | 4 o - odfl il?u:?rJlJo tufl 1: :fiut9tlu

z.z.z udntdu { 0 rfl A{ n : r {'u fr rh 1 ri'rfi n o r n r : m o ri der lq e, fr'r 1'hl fi r n : r {'uq _ '- | ---" d -

l#nol fiurnrurflfinruufin ueioroufln'ld'jrrflufi.rn:r{ul#rfioruaonntfil (inciter) r.riunt:o @ v a , d o 4 e -- _y q y3 - - { 9tooflflln{fl]u fl]:dilp'rdn?'rrJluu fil:14'l[:1u tljud{nrvEu lillnnficoqailHqa?nu?i{n:sEu

l#rfiprfinoqnrufiu irrutYrinr:dnrallufiaoaail (inducer) rdu ar:4frrr# {uriru '[:rirue--.q-.-e,,4ry'r y + i a + y cyo q q , Afrrtitri'ryfr{rJrudo{fi6nrAu{ fiofr.:n:v{u'lrirfrernr:d'nrdil"luilnoaail cirud.rn:v{uh?

d t4 I I o q - 4! q s dil ln lflaoaaufrr"hirioudrri'qfin tn:rsrfior:r;nurJ:nt#naoear:lill':siofrrn:v{u frrJrufiovhioAt-es)r!

rfl qolnl: [rJod]J ru6f d{n: e Eu rfi nlu

:.2.3 drrtufln?tuiutt:c tosl:nHoufrn rfio6'eurinutst"liln?txJ:urr:{ dsc 4-sdtaJort?ltllutr:{to{l:nilCIt-lfrq cfrtlr:6ruil{oonrilu + riu lpruordetflrril6 virsrotornt:?rou

dlJ::flnrv{iloe (FEV1 rio pepn) rirnrrrufi'uru?u1o{ PEFR

3.2.4 nr:{'qu'rYflHlsn:.Jn?'uJ!urr:.:1rorJ:nr ild'nnr:ro,1nr:1#€,rfnurl:n

,riunr:1dfl raeilrn n5orloucqI

ffuogjfi'un'lrilquu:{rorl:n #rl:n?urr:{rurfl0s6'ort#orrurn rfludu nr:lrnurfnurrsrflus q -q_----

..-.^.,J_-.,.q.q 4^.^;^..y^^,_-.--.-A A -J 4 rn,,,ty 4 A j J; il tt[ililnou 6l tilu]0]ncJuell[[A?flou 1 turuttJutuqr rn=o"tn"tnr{n il5ot5ilfrnrrIufr4lrrdrnioo 1__-.---d J a: i oJ .ne/nqu'rtJ'uilufl uytq1n{ lil00InI: Ft1Jur[nsfl ?ufiuoIn]:'[9i

:.2.s i'Fruzuunr:inurrdonarl:nrir6u rfro.rornd'nufl{exo{J:fliloufiodl - J 4 o dt y aililr v rnulrilu 1 uru 1 d'rriu r:ro-r,ilrrfludo{?r{ru{uh?frrjruqrrnd'rror'ldrfionnrI:nrirr?uqU

:.2.0 lr?nr:qrrn:hurriordor nrr:rie,{rJrorurnur,*orriarjlaruo rvrioqrmnfinr6tI I d

fl r : lf ut o'l a r : {r trfr r.,l r rn u I st : ?0 d}J : : o n tnil oqv4v

nt::RUtnt?vlur[r{rq8ililau

n I ?v fi o u #q ? u I t: { [a^ 0ufl d'u (severe exacerbations of asthma) rfl u n r rv fi n ul4y_!_ Att d J r A A9 aa vlFlu0u Ylllo{Qfltau Itavlilufl'l?vQfl[qumr{orr]:flr?{aiout{Hu{yteio{nt:nt:Tfrod'eJ rrnvnr:t q - -i-" --'

g--.-4,,"r- d a I o s99rt a 4^ lt9,|: f)u 1 yr f| fl 9l 0 { : ?9t [: ? il q y u u o I 0 0 y yt'l t 14 rulj ?urdu u?n [ 9t

n r : rfi q fl r ? v fi ou f q q u n: s rfr eJUil a'u o'r o o r,fi e, du 1 d' 1 u z ; rJ r ru u dr u tTu 6or9

;rJrrulfit rfinfruodxdl | (type 1 slow onset-late arrival) 1n0fifrlhoornr:riou 1 ra?a{v t 9)tt I 9)\ :- 4ilnru;u n'h{rJrurv}r'rvrurn\ild {rJrun{rufi:Tnrefidil::finrniloq{ir '[dfunr:inur

tnra 4q 4 r r i^ j d '"lrirfiertv{o fiiliyrinr.ro^srt'ls cirugrJrrrufrrn=eilu:rfll5?ilrn nrulill?a] t *'rJils (we 2

sudden onset) or r osrfi q o rnrrfrurn dru Nsap rr#o ru r: rrfiar:nfr rrfiqq

3 .g n ? 1 il irdu a ffu rn #ri n s I I ra v R 1 : il s r u I a ?i{h u iil#s r{ - ----ci- --

3.3.1 berodual fort rfluarfifiqvrfi"lunr:ruruilaoqnilsaiohdrt: 9r fl ou14 9t yt tJ o]fl 'l: l0rlju o'1fl 'l: dln aJ

uav'hiartr:fl u: :rm t'[dJeeldurr fl rafi aoeail fi 1#lunr: ins irJn6

3. 3. 3 venro I in 1 #rir n :-u :'n u r I : n r o u #q rfi u u fl n'u yfi n : u r r: I

r.+ uuefiofflflunr:drrfiunr:

llOtl Gordon

uty I

tqrrn

tdfnurfr:ho

3.3.2 dexamethasone : vSu o i n r : d'n rau ua s tdfnu r I : n r o u #n d o r n r : q u u:,:

3.+. t :J : s rfi u R r ?y qx R rn {rJ r oor r :L n: o u uu ? fi n r o { n r : d : s rfi u R'r ?s dll R -r y,l

* d d, yq 4 A o o to 443.4.2 tfl :.rd5 t{o{nn rrruf Iu gran j mrlnr:ilurur nfr u rrLr]dlu n: fi frnur

3 .4.2. I vr q u fr fi 'r ur er do il'[u fi s rn n (Nightingale, s environmental theory)

3.4.2.2 vrqufinr:qrlanulo{qlo{Iorf ru (orem,s self care system theory)

n. aiilsr:ydr6'€ul,o{rduu,,ur#u"uunr:rirrfi unr:qs

+.r a:rjar:yairffarllosdosqs

1 u fl t q riu rvr n I u I aE rt ?iy rir ru rii 1 :J o rj r { il r n ri r 1 #rfi q il a n r': s d rfl u n'u un v

drl#anrnornrsnjduutuJas drflnt#rl:vsrn::J'lurflul:nnou#flnailru,,rudu rudosr{rq

v a o q I a d J , < q tg)t:ufl'l::nurslelu [:.:nutlro vtt]t4'tn-qnrrrumn{m:rurufi'l:rlnro o-qrlo rrri{rJrurrav

n:olnf'l anoetufiotrflrfrqnrrilrfiuurumrrre:rugn^orotffrJruunvr-l:yrngryrfi nsrurndqfi

uvrlrvrrirri'qlunr:1#druuvdr niun,rq,,ururol nr:udn,fiuua'r,nq ufie:lo,:ti'u'hj1#ernr:o A o J J - t q gtgttt o da I r anrtiuttastn=nfl?1il?uu:surnfru vr'rilrli'1u1fi{rJ':udr:rfiiflodrlilnfiqtrravfiqcunrufrisrfi6

tt

n : fi dnu r ffrl e u vr u ln uo r q 63 TJ dfl r u n r?r crr, : a rdu sr n^'lvr u r{r fu n r : fnu r

si'rluJ:rvrululunuludr?e':qrifrntqunvqnrfiu r?ar 06.30 urfinr iufi re ?rqunrflrJ 2553

:J:vifini:rfiurJrslufltqriu t iuriou;rrl:riluiuro {rJrofiornrrnuu,"duuilrn u?lil1144 u t d!?u0qu?rrilu l:nmolrorasuytiiu r{rilnr:fnurvtre{:Jrortinorq:fl::u iufr t6

)8.00 u r frn r td'ir n r : fnu "r er rrl o rn r : qr o r I: n fi n rrv rrm : ndou 6orj oer

d'nrau nrry'lri6rilqaro.rrr''rr.i'r,,uunfiorrdluirqnru rrar#or4n ldfrnr:rrd'ltrut

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