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    Bronchial Asthma

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    chandrikaismail
    This document discusses bronchial asthma and its management. It provides background on Khalid, a 14-year-old asthmatic patient who presents with shortness of breath. The document outlines objectives in caring for asthma patients and discusses the prevalence, pathophysiology, triggers, diagnosis, classification, and evidence-based management of asthma. It proposes developing clinical algorithms for managing asthma in adults, children, and emergencies in primary care clinics.

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    Bronchial Asthma

    Uploaded by

    chandrikaismail
    129 views27 pages
    This document discusses bronchial asthma and its management. It provides background on Khalid, a 14-year-old asthmatic patient who presents with shortness of breath. The document outlines objectives in caring for asthma patients and discusses the prevalence, pathophysiology, triggers, diagnosis, classification, and evidence-based management of asthma. It proposes developing clinical algorithms for managing asthma in adults, children, and emergencies in primary care clinics.

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    This document discusses bronchial asthma and its management. It provides background on Khalid, a 14-year-old asthmatic patient who presents with shortness of breath. The document outlines objectives in caring for asthma patients and discusses the prevalence, pathophysiology, triggers, diagnosis, classification, and evidence-based management of asthma. It proposes developing clinical algorithms for managing asthma in adults, children, and emergencies in primary care clinics.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    129 views27 pages

    Bronchial Asthma

    Uploaded by

    chandrikaismail
    This document discusses bronchial asthma and its management. It provides background on Khalid, a 14-year-old asthmatic patient who presents with shortness of breath. The document outlines objectives in caring for asthma patients and discusses the prevalence, pathophysiology, triggers, diagnosis, classification, and evidence-based management of asthma. It proposes developing clinical algorithms for managing asthma in adults, children, and emergencies in primary care clinics.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 27

    BRONCHIAL

    ASTHMA
    YOUSEF ABDULLAH AL TURKI
    MBBS,DPHC,ABFM
    Associate Professor
    Consultant Family Medicine
    King Khalid University Hospital
    College of Medicine
    King Saud University

    CASE SCENARIO
    Khalid 14 years old come to the clinic c/o
    shortness of breath for one day duration.
    He is a known asthmatic patient for more
    than 8 years, he visited A/E frequently.
    His school performance is below average,
    with frequent absence from school due to
    his illness.

    HOW YOU WILL PROCEED


    DURING THIS CONSULTATION ?

    What are your objectives in caring


    for bronchial asthma patient ?

    Prevent troublesome
    symptoms night and
    day
    Prevent serious
    attacks
    Require little or no
    reliever medication
    Have productive,
    physical,
    psychological, and
    social active lives

    WHAT IS BRONCHIAL
    ASTHMA?

    Asthma is a CHRONIC INFLAMMATORY


    disorder of the airways.
    Chronically inflamed airways are hyper
    responsive;
    they become obstructed and airflow is
    limited by bronchoconstriction,mucus
    plugs, and increased inflammation when
    airways are exposed to various risk
    factors.

    WHAT IS THE PREVALENCE IN


    SAUDI ARABIA ?

    The prevalence of asthma among


    school children in K.S.A ( AL Frayh,
    Range
    et al )
    4%-23%
    Riyadh
    10%
    Jeddah
    12%

    What is the Pathophysiology?


    Trigger Factor
    Mast cell
    Mediators :
    histamine,prostaglandin,leukotrienes,as
    well as cytokines.
    Inflammatory cells
    Sustained Inflammatory response
    Contraction of airway smooth muscles
    (Bronchoconstriction)

    Pathophysiology (Cont.)
    Airway wall swelling (mucosal edema)
    Airway hyper responsiveness
    Chronic changes
    Hypertrophy of the smooth muscles,
    thickening of the basement membrane
    Airway remodeling
    There is good evidence that asthma occurs
    in families.

    What are the Triggering Factors?


    Domestic dust
    mites
    Air pollution
    Tobacco smoke
    Occupational
    irritants
    Cockroach
    Animal with fur
    Pollen

    Triggering Factors ( cont.)


    Respiratory (viral)
    infections
    Chemical irritants
    Strong emotional
    expressions
    Drugs ( aspirin,
    beta blockers)

    CASE SCENARIO
    Ahmed 6 years old come to primary
    care clinic with his father c/o chronic
    cough for the last 3 months, mainly
    at night .

    How you will approach this


    patient?

    HOW TO DIAGNOSE BRONCHIAL


    ASTHMA ?
    Consultation

    skill
    Relevant History
    -Symptom
    -history of allergic disease
    -Family history
    -Environmental history
    -Exclusion of other medical
    condition

    Diagnosis of B.A ( cont.)


    Relevant

    physical examination
    Investigation
    Do you need to do investigation?
    Why ?
    Follow up
    Medical record
    Role of Peak Flow Meter

    CLASSIFY ASTHMA SEVERITY


    Mild

    intermittent Asthma (step1)


    Mild persistent Asthma (step2)
    Moderate persistent Asthma (step3)
    Severe persistent Asthma (step4)

    How to manage and control


    Bronchial Asthma
    Educate

    patients to develop a
    partnership in asthma care
    Assess and monitor asthma severity
    Avoid exposure to trigger factors
    Establish individual medication plans
    for long term management in
    children and adults

    How to manage and control


    Bronchial Asthma ( cont.)
    Establish

    individual plans to manage


    asthma attacks
    Provide regular follow up care.

    Stepwise approach ( children)


    classificati
    on
    Minor
    symptoms
    exacerbati
    on/
    nocturnal
    PEF
    between
    attacks

    mild
    Intermitte
    nt
    < 1/week

    Mild
    persistent

    Moderate
    persistent

    Severe
    persistent

    1-3 /week

    4-5/week

    Continuou
    s

    < 1/month 1 /month

    2-3/month > 4
    /month

    >80%

    >80%

    60-80%

    < 60%

    Step 1

    Step 2

    Step 3

    Step 4

    Stepwise approach ( adult)


    classificati
    on
    Minor
    symptoms
    exacerbati
    on/
    nocturnal
    PEF
    between
    attacks

    mild
    Intermitte
    nt
    < 2 /week

    Mild
    persistent

    Moderate
    persistent

    Severe
    persistent

    2-3 /week

    4-5 /week

    Continuou
    s

    <2
    /month

    2-3
    /month

    4-5
    /month

    >5
    /month

    >80%

    >80%

    60-80%

    < 60%

    Step 1

    Step 2

    Step 3

    Step 4

    Evidence Based approach


    Clinical

    evidence
    http://www.clinicalevidence.org
    Cochrane library
    http://www.cochrane.org/

    Evidence Based approach


    (example)
    Clinical

    Evidence
    What are the effects of treatments
    for chronic asthma?
    what are the effects of treatments
    for acute asthma?
    - Beneficial
    - Likely to be Beneficial
    - unknown effectiveness

    INTERNET SITE
    Guidelines

    NHLBI/ WHO report


    http://www.ginasthma.com
    Cochrane Site:
    http://www.cochrane.org/
    Clinical Evidence:
    http://www.clinicalevidence.org

    QUESTIONS ????

    THANK YOU
    WITH MY BEST REGARDS

    PRACTICAL
    GROUP (A)
    - Simple clinical algorithm for management
    of bronchial asthma among ADULT in
    PHC clinic
    GROUP (B)
    - Simple clinical algorithm for management
    of bronchial asthma among CHILDREN in
    PHC clinic
    Group (c)
    - Simple clinical algorithm for management
    of bronchial asthma in EMERGENCY

    REFERENCES and FURTHER


    READINGS
    The National Scientific Committee of
    Bronchial Asthma in Saudi Arabia. The
    National Protocol for the management of
    Asthma, fourth edition1424/2003.
    National Heart, lung, and Blood Institute,
    National Institute of Health. WHO
    workshop report. Global Strategy for
    Asthma Management and
    Prevention,2002.

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