Bronchial Asthma

BRONCHIAL ASTHMA
Bronchial Asthma
 5 % of population is affected
 4.7 million admissions/annum
 5000 deaths
 Hospitalization rate highest among
children
Pathophysiology
 Chronic inflammatory condition of lung
airways
 Airflow limitation which is usually
reversible spontaneously or with
treatment
 Airway hyper responsiveness to a wide
range of stimuli
Pathophysiology
 Inflammation of the bronchi
 T lymphocytes, mast cells,
eosinophils ,plasma exudation,
 Oedema , smooth muscle hypertrophy,
matrix deposition,
 Mucus plugging and epithelial damage.
Bronchial Asthma
Etiology and Precipitants
 Genetic predisposition
 URTI
 Exercise
 Emotional stress
 Weather
Bronchial Asthma
Etiology and Precipitants
 PND
 GERD
 Tobacco smoke
 Drugs
 Gases
 Occupational
 Exercise
Classification
 Extrinsic asthma: atopic individuals
 Intrinsic asthma: middle age (‘late

onset’).
Bronchial Asthma
Symptoms
 Cough
 Sputum
 Tightness of chest
 Wheezing
 Breathlessness
 Circadian rhythm
Bronchial asthma
Symptoms
Hemoptysis?
Chest pain
Fever
Other associated allergic features
1. Eczema
2. Atopic dermatitis
Bronchi Asthma
Signs
 Tachypnea
 Restlessness
 Accessory muscle use
 Tachycardia/Bradycardia
 Hypotension
 Pulsus paradoxus
 Fever
Bronchial asthma
Signs
 Prolonged expiration
 Rhonchi
1. Inspiratory
2. Expiratory
 Crepts
Classification Of Asthma Severity
 MILD INTERMITTENT
 MILDPERSISTENT
 MODERATE PERSISTENT
 SEVERE PERSISTENT
FREQUENCY OF SYMPTOMS
 Less then 2 times a week, asymptomatic
and normal PEFR between
exacerbations
 More than 2 times a week and less than
1 time a day
 Daily symptoms, exacerbations more
than 2 times a day
 Continuous symptoms, frequent
exacerbations
Night- Time Symptoms
 LESS THAN 2 TIMES A MONTH
 GREATER THAN 2 TIMES A MONTH
 GREATER THAN 1 TIME A WEEK
 FREQUENT
PEFR
 GREATER THAN 80%
 GREATER THAN 80 %
 60-80%
 LESS THAN 60%
CLASSIFICATION OF SEVERITY OF
ASTHMA EXACERBATION
 MILD
 MODERATE
 SEVERE
 IMPENDING RESPIRATORY FAILURE
Criteria
 Brearthlessness
 Speech
 Body position
 Resp.rate
 Breath sounds
 Heart rate
 Pulses paradoxus
Investigations
 Blood C/E
 Sputum C/E
 CXR
 PEFR
 Spirometry
 Skin testing
 ABG
TREATMENT
vere persistent asthma
Moderate
persistent
Mild
persistent
asthma
Mild
intermittent
Asthma
Treatment
Drugs
QUICK RELIEF MEDICATIONS

1. BETA ADRENERGIC AGENTS
2. ANTICHOLINERGICS
3. PHOSPHODIESTERASE INHIBITORS
4. GLUCOCORTICOIDS
5. ANTIBIOTICS
Treatment
Drugs
LONG TERM CONTROL MEDICATIONS
1. CORTICOSTEROIDS
2. LONG ACTING BETA ADRENERGIC
AGENTS
3. LEUKOTREINR MODIFIER
 5-lipoxygenase enzyme inhibitors
 leukotriene receptor antagonist
(Zafirlukast
Treatment
Drugs
4. PHOSPHODIESTERASE INHIBITORS
5. DESENSITISATION
Mild intermittent
 No daily medication
 Short acting inhaled bronchodilators for
quick relief
 Use greater than two times a week
indicate long term therapy
 Education
Mild persistent
 Once daily medication

 Anti inflammatory
Inhaled Corticosteroids low doses
 Sustained release theophylline
Mild persistent
 Short acting bronchodilators for quick

relief
 Daily use of bronchodilators needs for
long term therapy
 Education
Moderate persistent
 Inhaled anti inflammatory (Medium
dose steroids)
or
 Steroids plus long acting
bronchodilators inhalers or if needed
 Tablets of theophylline or B2 agonists
 Short acting bronchodilators on need
basis
 Education
Severe persistent
 Daily medication
 Inhaled Anti inflammatory high dose steroids
PLUS
 Long acting inhaled bronchodilators
PLUS
 Oral Corticosteroids
 Short Acting oral Beta agonist for quick relief
 Education
Treatment of Acute exacerbation of
Asthma
 High dose Oxygen to keep PO2 more
than 67 mm of hg
 Inhaled or nebulised salbutamol
 Intravenous hydrocortisone
 Intravenous Aminophylline
 Intravenous salbutamol
 CXR
Treatment of Acute exacerbation of
Asthma
 Consider admission
 Oral steroids
 Indications for ventilation
 Antibiotics

Bronchial Asthma

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BRONCHIAL ASTHMA

 Intrinsic asthma: middle age (‘late

QUICK RELIEF MEDICATIONS

 Once daily medication

 Short acting bronchodilators for quick

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