ASTHMA

Jailani, Shameem S.
ASTHMA
➤ - is a syndrome characterized
by airflow obstruction that
varies markedly, both
spontaneously and with
treatment. -Asthmatics harbor
a special type of inflammation
in the airways that makes them
more responsive than
nonasthmatics to a wide range
of triggers, leading to excessive
narrowing with consequent
reduced airflow and
symptomatic wheezing and
dyspnea.
EPIDEMIOLOGY
➤ 300 million people worldwide
➤ 10–12% of adults and 15% of children affected
➤ Most patients with asthma in affluent countries are atopic, (with allergic
sensitization to the house dust mite Dermatophagoidespteronyssinus and
other environmental allergens)
➤ peak age of 3 years
➤ In childhood, male female 2:1, but by adulthood the sex ratio has equalize.
➤ Major risk factor of asthma death:
➤ - Poorly controlled disease with frequent use of bronchodilators
➤ -Lack of corticosteroid treatment
➤ -Prevent hospital with near fatal asthma
RISK FACTORS AND TRIGGERS OF ASTHMA
CLINICAL MANIFESTATION

➤ 1. wheezing,
➤ 2. dyspnea
➤ 3. coughing

➤ Symptoms may be worse at night and patients typically awake in the early
morning hours.
➤ signs: tachypnea, tachycardia, mild systolic HPN
➤ There may be increased ventilation and use of accessory muscles of ventilation.
Prodromal symptoms may precede an attack, with itching under the chin,
discomfort between the scapulae, or Inexplicable fear (impending doom).
➤ Typical physical signs are inspiratory, and to a greater extent expiratoryrhonchi
throughout the chest, predominant nonproductive cough (cough-variant asthma)
young children
DIAGNOSIS
➤ Pulmonary function tests
➤ Simple spirometry
➤ confirms airflow limitation
➤ with a reduced FEV 1 , FEV 1 /FVC ratio, and PEF
➤ Reversibility is demonstrated by a >12% and 200-mL increase in FEV 1 15 minutes after an inhaled short-acting β 2 -agonist
or in some patients by a 2 to 4 week trial of oral corticosteroids (OCS) (prednisone or prednisolone 30–40 mg daily).
➤ Measurements of PEF twice daily : may confirm the diurnal variations in airflow obstruction.
➤ Flow-volume loops show reduced peak flow and reduced maximum expiratory flow.

➤ lung function test

➤ diurnal variability of PEF (using peakflow meter)
➤ ↑airwayresistance, ↑total Lung volume & residual volume as detected by body plethysmograph

➤ whole body plethysmography

➤ increased airway resistance
➤ increased total lung capacity and residual volume
➤ Gas diffusion normal, but there may be a small increase in gas transfer in some patients.
➤ Airway responsiveness
➤ Broncoprovocative test
➤ o Only done if diagnosis is doubtful
➤ o Test for PC 20

➤ Pharmacological agents:
➤ measured by methacholine or histamine

➤ Physical stimuli –
➤ exercise
➤ immunologic stimuli – pollen & other allergens
➤ Hematologic tests
➤ Blood tests are not usually helpful.
➤ Total serum IgE
➤ specific IgE to inhaled allergens [radioallergosorbent test
(RAST)]
➤ Imaging: not diagnotic
➤ Chest roentgenography(CXR)
➤ o finding usually normal o evidence of a pneumothorax(complication).
➤ o Lung shadowing usually indicates pneumonia or eosinophilic
infiltrates in patients with bronchopulmonaryaspergillosis.
➤ o hyperinflation – cases of severe acute asthma & during exacerbation

➤ High-resolution CT
➤ o may show areas of bronchiectasis in patients with severe asthma
➤ o thickening of the bronchial walls
➤ Skin tests
➤ Ò note allergens
➤ · positive in allergic asthma
➤ · negative in intrinsic asthma
➤ · part of allergen avoidance measure

➤ Exhaled nitric oxide

➤ Ò to check severity of airway
➤ · noninvasive test measuring eosinophilic airway inflammation.
➤ · It may also be useful in demonstrating insufficient anti-inflammatory therapy.
➤ · to monitor adequacy of treatment & compliance
LEVEL OF ASTHMA CONTROL
 TREATMENT
➤ RELIEVER:
➤ v Cathecholamine
➤ · Epinephrine, isoproterenol,
isoethanol
➤ v Beta 2 agonist
➤ · Saligenin-salbutamol
➤ · Terbutaline
➤ v Anti cholinergic
➤ v Theophylline
➤ v Systemic CTZ
➤ CONTROLLER
➤ v Long acting beta 2 agonist
➤ v Steroids
➤ v Cromolyn Na
➤ v Leukotrienes receptor
antagonist
➤ v theophylline
➤ MANAGEMENT APPROACH BASED IN CONTROL TREATMENT STEPS
➤ For all treatment steps
➤ o asthma education
➤ o environmental control
➤ o as needed rapid B2 agonist

➤ 1. STEP 1 · Controller options

➤ 2. STEP 2 · Low dose ICS or leukotriene modifier
➤ 3. STEP 3 a. ICS + long acting B2 agonist b. Med to high dose ICS c. Low dose ICS +
leukotriene modifier d. Low dose ICS + sustained release theophylline
➤ 4. STEP 4 (add one or more of the following) a. 3a + med. To high dose inhaled CS +
long acting B2 agonist b. 3b + leukotriene modifier c. 3c + sustained release theophylline
➤ 5. STEP 5 (refractory asthma) a. Oral glucocorticoid (lowest dose) b. Anti IgE tx
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