Bronchial asthma

Dr. Randula Samarasinghe

Consultant physician
 Definition
Bronchial asthma is a chronic
inflammatory condition of the air
ways in which there is reversible and
variable air way obstruction with
increased bronchial
hyperresponsiveness
 Common
Prevlence > 15 to 20 % in Sri Lanka
Asthma can kill
Reduces quality of life
Treatable
 Aetiology of Asthma
Atopy or allergic asthma
- Extrinsic
- Intrinsic Asthma

Non atopic asthma or non allergic

asthma
 Precipitating factors
Allergens
Infections
Irritants
Chemicals
Exercise
Emotions
Drugs
Changers in temperature
 Pathophysiology
in atopy
Atopy is a state of disordered immunity
Increased T helper type II immune response to
antigen exposure

Increased IgE production

Mast cell degranulation

Increased eosinophil activity

Inflammation of air ways

Pathological changes in the air ways

Smooth muscle hypertrophy

Inflammatory cell infiltration
Mucosal oedema
Goblet cell hypertrophy
Mucus hypersecretion
Protein and collagen deposition
Epithelial deposition
 Air way remodelliing
The inflammatory changes in the
airway can cause permanent
changes in the air ways

- subepithilial fibrosis
- smooth muscle and goblet cell
hyperplasia
 Clinical features
Symptoms
Wheeze
Shortness of breath
Cough
Chest tightness
 Signs
Rhonchi > diffuse
> Polyphonic
> Bilateral
> Expiratory
May be > Scanty
> monophonic
> unilateral
> Absent signs
 Clinical features
May be other atopic phenomina in
the patient or family
 Asthma variants
Cough variant asthma
 Differential Diagnosis
COPD
Congestive cardiac failure
Bronchiactasis
other
 Diagnosis
History
Examination
Demonstration of reversibility of air flow
obstruction

History and examination allows for

fairly accurate diagnosis but
confirmation is ideally by demonstration
of air reversibility of air way obstruction
Demonstration of reversibility of air
way obstruction
> 15 % increase in FEV1 after two
puffs of beta adrenergic agonist

Serial PEFR measurement

some patients with < 15 % may still
have asthma and serial PEFR can be
helpful in the diagnosis > 15%
diurnal variation
 some patients with < 15 % may still
have asthma and reversibility may
elicited in the following ways

Serial PEFR measurement

Improvement in FEV1 after oral or

inhaled steroids
 Investigations
FBC > eosinophilia
CXR > to rule out other causes and
Identify infection of lungs
Skin prick test > to find the allergen
 Management
Acute exacerbation
Long term management of stable
asthmatics
 Management
Long term
Non pharmacological management
> Primary prevention
> Breast feeding
> Dietary modifications
> Microbial exposure
 Non pharmacological management

> secondary prevention

> Allergens avoidance
> Environmental factors
> Exercise
> Diet
> Drugs
 Management
Long term
Pharmacological
> preventers and relievers
> Inhalers and tablets
> Tailored to the severity of the
disease
 Asthma can be classified according to
severity of symptoms and FEV1 values of
the patient

> Intermittent
> Persistent
> mild
> moderate
> severe
 Relievers
selective beta 2 agonist
> stimulate beta2 receptors in
bronchial
smooth muscle
> short acting and long acting
> Inhalation or orally
 Relievers

> Theophyllins
> anti muscarinics
 Preventers
> Corticosteroids
> Reduces air way inflammation
and mucosal oedema
> Inhalation and orally
> Cromoglycates
> mainly used in peadiatric practice
in exercise induced asthma
 Other drugs in Asthma
Leukotriens
Thank you