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    Asthma: Kinyua Md. MCM - A & E MKU Facilitator: Dr. Ayunga

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    Dennis Miriti
    Asthma is a chronic airway disease characterized by inflammation, airway hyperresponsiveness, and variable airflow obstruction. It is common in both children and adults. While the exact causes are unknown, asthma is often triggered by allergens and irritants. Diagnosis involves assessing symptoms and lung function tests. Treatment involves controllers like corticosteroids to prevent symptoms and relievers like bronchodilators for acute exacerbations. Management focuses on education, trigger avoidance, and pharmacologic therapy via inhalers.

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    Asthma: Kinyua Md. MCM - A & E MKU Facilitator: Dr. Ayunga

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    Dennis Miriti
    43 views28 pages
    Asthma is a chronic airway disease characterized by inflammation, airway hyperresponsiveness, and variable airflow obstruction. It is common in both children and adults. While the exact causes are unknown, asthma is often triggered by allergens and irritants. Diagnosis involves assessing symptoms and lung function tests. Treatment involves controllers like corticosteroids to prevent symptoms and relievers like bronchodilators for acute exacerbations. Management focuses on education, trigger avoidance, and pharmacologic therapy via inhalers.

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    Asthma is a chronic airway disease characterized by inflammation, airway hyperresponsiveness, and variable airflow obstruction. It is common in both children and adults. While the exact causes are unknown, asthma is often triggered by allergens and irritants. Diagnosis involves assessing symptoms and lung function tests. Treatment involves controllers like corticosteroids to prevent symptoms and relievers like bronchodilators for acute exacerbations. Management focuses on education, trigger avoidance, and pharmacologic therapy via inhalers.

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    43 views28 pages

    Asthma: Kinyua Md. MCM - A & E MKU Facilitator: Dr. Ayunga

    Uploaded by

    Dennis Miriti
    Asthma is a chronic airway disease characterized by inflammation, airway hyperresponsiveness, and variable airflow obstruction. It is common in both children and adults. While the exact causes are unknown, asthma is often triggered by allergens and irritants. Diagnosis involves assessing symptoms and lung function tests. Treatment involves controllers like corticosteroids to prevent symptoms and relievers like bronchodilators for acute exacerbations. Management focuses on education, trigger avoidance, and pharmacologic therapy via inhalers.

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    ASTHMA

    KINYUA MD.
    MCM – A & E
    MKU
    FACILITATOR: DR. AYUNGA
    DEFINITION
    • Asthma is an airway disease characterized by chronic
    inflammation, hyper responsiveness with exposure to a
    wide variety of stimuli, and variable airflow obstruction.
    • As a consequence, patients have paroxysms of cough,
    dyspnea, chest tightness, and wheezing.
    • Asthma is a chronic disease with episodic acute
    exacerbations that are interspersed with symptom-
    free periods.
    • Exacerbations are characterized by a progressive increase
    in asthma symptoms that can last minutes to hours.
    EPIDEMIOLOGY
    • In the united states, asthma is the leading chronic
    illness among children (20% to 30%) (NCHS data brief
    2012;1).
    • The prevalence of asthma and asthma-related mortality
    had been increasing from 1980 to the mid-1990s, but
    since the 2000s, a stabilization in prevalence and
    decrease in mortality has occurred.
    • Currently, it is estimated that asthma affects 1-18% of
    the general population in each country. (GINA report,
    2018) (ISAAC STUDIES) Kenya 10%.
    ETIOLOGY

    • The fundamental causes of asthma are not completely


    understood
    • However a combination of genetic predisposition with
    environmental exposure to inhaled substances and
    particles that may provoke allergic reactions or irritate
    the airways, such as:
    • Indoor allergens (for example, house dust mites in
    bedding, carpets and stuffed furniture)
    • Outdoor allergens (such as pollens and pollution
    and pet dander, moulds)
    ETIOLOGY CNT..
    • Tobacco smoke
    • Chemical irritants in the workplace
    • Air pollution.
    • Other triggers can include cold air, extreme emotional
    arousal such as anger or fear, and physical exercise
    PATHOPHYSIOLOGY
    • Asthma is characterized by airway obstruction,
    hyperinflation, and airflow limitation resulting from
    multiple processes:
    Acute and chronic airway inflammation characterized
    by infiltration of the airway wall, mucosa, and lumen by
    activated eosinophils, mast cells, macrophages, and T
    lymphocytes.
    Bronchial smooth muscle contraction resulting from
    mediators released by a variety of cell types including
    inflammatory, local neural, and epithelial cells.
    Epithelial damage manifested by denudation and
    desquamation of the epithelium leading to mucous plugs that
    obstruct the airway.
    Airway remodeling characterized by the following findings:
    • Sub epithelial fibrosis, specifically thickening of the lamina
    reticularis from collagen deposition
    • Smooth muscle hypertrophy and hyperplasia
    • Goblet cell and submucosal gland hypertrophy and
    hyperplasia resulting in mucus hypersecretion
    • Airway angiogenesis
    • Airway wall thickening due to edema and cellular infiltration
    DIAGNOSIS

    Diagnostic criteria
    • In general, the diagnosis is supported by the presence
    of symptoms consistent with asthma combined with
    demonstration of variable expiratory airflow
    obstruction.
    • Adequate response to asthma treatment is a valid
    method to assist with making the diagnosis.
    History
    • Recurring episodes of cough, dyspnea, chest tightness, and
    wheezing are suggestive of asthma. Symptoms occur most
    often at night or early morning, in the presence of potential
    triggers, and/or in a seasonal pattern.
    • A personal or family history of atopy can increase the
    likelihood of asthma.
    Physical examination
    • Auscultation of wheezing and a prolonged expiratory
    phase can be present on exam, but a normal chest exam
    does not exclude asthma.
    • Signs of atopy, such as eczema, rhinitis, or nasal polyps,
    often coexist with asthma.
    • During a suspected asthma exacerbation, a rapid
    assessment should be performed to identify those
    patients who require immediate intervention.
    • Respiratory distress and/or peak expiratory flow
    (PEF) of <25% of predicted.
    • The presence or intensity of wheezing is an
    unreliable indicator of the severity of an attack.
    • Subcutaneous emphysema should alert the
    examiner to the presence of a pneumothorax or
    pneumomediastinum.
    Classification of Asthma Exacerbation
    Severity
    DIAGNOSIS: LABORATORY STUDIES

    • Routine laboratory tests are not indicated for the


    diagnosis of asthma and should not delay the initiation of
    treatment.
    • During an exacerbation, monitor oxygen saturation.
    • ABG measurement should be considered in patients in
    severe distress or with an fev1 of <40% of predicted
    values after initial treatment.
    • A pao2 <60 mmHg is a sign of severe
    bronchoconstriction or of a complicating condition, such
    as pulmonary edema or pneumonia.
    • Initially, the paco2 is low due to an increase in
    respiratory rate. With a prolonged attack, the paco2 may
    rise as a result of severe airway obstruction, increased
    dead space ventilation, and respiratory muscle fatigue.
    • A normal or increased paco2 is a sign of impending
    respiratory failure and necessitates hospitalization.
    IMAGING

    • Obtaining a chest radiograph is not routinely required


    and is performed only if a complicating pulmonary
    process, such as pneumonia or pneumothorax, is
    suspected or to rule out other causes of respiratory
    symptoms in patients being evaluated for asthma.
    • Computerized tomography of the chest can be
    considered in patients with severe asthma refractory to
    treatment to evaluate for alternative diagnosis.
    Diagnostic procedures
    • Pulmonary function tests (PFTs) are essential to the
    diagnosis of asthma.
    • In patients with asthma, PFTs demonstrate an
    obstructive pattern—the hallmark of
    • Which is a decrease in expiratory flow rates.
    MANAGEMENT OF ASTHMA
    1. “Relievers”
    I. Short-acting bronchodilators
    A. Β 2-adrenergic agents
    B. Anti-cholinergic (parasympatholytic) agents
    2. “Controllers”
    1. Corticosteroids
    2. Long-acting bronchodilators
    I. Β 2 -adrenergic agents
    Ii. Methylxanthines
    3. Mast cell stabilizers.
    4. Leukotriene inhibitors
    5. Anti-Ig E monoclonal antibodies
    TREATMENT - PRINCIPLES
    • Educate parent – triggers, recognize exacerbations,
    medication
    • Avoidance of exposure to triggers
    • Pharmacologic management
    • Of acute exacerbations: RELIEVER
    MEDICATIONS
    • Long-term – CONTROLLER MEDICATIONS (for
    persistent asthma)
    • Inhaled route optimal for most drugs
    • Any persistent form of asthma, controlled more
    effectively by suppressing and reversing airway
    inflammation than by treating only acute broncho-
    constriction and related symptoms
    PHARMACOLOGIC TREATMENT
    Two broad types of medication:
    1. CONTROLLER medications
    • Used for persistent forms of asthma
    • Used to PREVENT asthma symptoms
    • Aim at achieving long-term control
    • Are generally anti-inflammatory drugs
    • Some immune modulating drugs show promise
    II . RELIEVER medications
    • Used in all classes of asthma
    • Used to treat acute asthma symptoms
    • Aim at rapidly relieving symptoms, and aborting the
    exacerbation
    • Are generally rapid acting, short acting beta2 agonists, or
    anticholinergic drugs
    TREATMENT OF ACUTE ASTHMA
    EXACERBATION
    Assess severity of the attack (talking, RR, agitation,
    ability to breastfeed-infant, pulse oximetry)
    • Mild attack: talks normal sentences, Sao2 >95%
    • Moderate: phrases, agitated, RR↑, reduced
    breastfeeding, Sao2 >91-95%
    • Severe: single words, drowsy or confused, RR↑↑,
    unable to breastfeed, +/-paradoxical breathing, Sao2
    <90%
    TREATMENT OF ACUTE ASTHMA
    EXACERBATION
    • Give SABA (inhaler + spacer, nebulized) up to 3 treatments
    in 1 hour (variable delivery to lower airways!)
    • Observe at least 3 hours
    • If symptoms return in <3hrs, or fail to improve
    • Add inhaled anticholinergic to SABA
    • Add oral corticosteroid (OCS)
    • If still no improvement, admit to hospital
    • Give humidified oxygen (nasal canula)
    • Continue SABA + Anticholinergic,
    • Continue systemic glucocorticosteroid
    • Consider IV methylxanthines (monitor levels)
    • Monitor closely
    ASTHMA COMPLICATIONS
    REFERENCES

    • (GINA report, global strategy for asthma management and prevention,


    2018,www.Ginasthma.Org; national asthma education and prevention
    program expert panel report 3, 2007,
    http://www.Nhlbi.Nih.Gov/guidelines/asthma/asthgdln.Pdfnchs data
    brief 2012;1).
    • Washington manual of medical therapeutics 2014.
    Www.Ketabpedeshki.Com

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