Management of asthma seminar

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  • Spacers can help patients who have difficulty with inhaler use and can reduce potential for adverse effects from medication SERETIDE ACCUHALER: 60 puff per accuhaler
  • Managing Asthma: Peak Flow Chart
  • Management of asthma seminar

    1. 1. MANAGEMENT OF BRONCHIAL ASTHMA NOOR HAFIZAH BINTI HASSAN 2007287236
    2. 2. REFERENCES <ul><li>GLOBAL INITIATIVE FOR ASTHMA </li></ul><ul><li>GLOBAL STRATEGY FOR ASTHMA MANAGEMENT </li></ul><ul><li> AND PREVENTION </li></ul><ul><li>UPDATED 2009 </li></ul><ul><li>GUIDELINES ON MANAGEMENT OF ADULT ASTHMA </li></ul><ul><li>MALAYSIAN THORACIC SOCIETY </li></ul><ul><li>2002 </li></ul>
    3. 3. GOALS OF MANAGEMENT <ul><li>ACHIEVE AND MAINTAIN CONTROL OF SYMPTOMS </li></ul><ul><li>MAINTAIN NORMAL ACTIVITY LEVEL, INCLUDING EXERCISE </li></ul><ul><li>MAINTAIN PULMONARY FUNCTION AS CLOSE TO NORMAL AS POSSIBLE </li></ul><ul><li>PREVENT ASTHMA EXACERBATION </li></ul><ul><li>AVOID ADVERSE EFFECT FROM ASTHMA MEDICATIONS </li></ul><ul><li>PREVENT ASTHMA MORTALITY </li></ul>
    4. 4. <ul><li>DEVELOP PATIENT/DOCTOR RELATIONSHIP </li></ul><ul><li>2. IDENTIFY AND REDUCE EXPOSURE TO RISK FACTORS </li></ul><ul><li>3. ASSESS, TREAT AND MONITOR ASTHMA </li></ul><ul><li>4. MANAGE ASTHMA EXACERBATION </li></ul>APPROACH TO MANAGEMENT
    5. 5. 1. DEVELOP PATIENT/DOCTOR RELATIONSHIP <ul><li>Aim of partnership  guided self-management </li></ul><ul><li>Patient education: </li></ul><ul><ul><li>Nature of asthma </li></ul></ul><ul><ul><li>Preventive measures/avoidance of triggers </li></ul></ul><ul><ul><li>Drugs used & their side effects </li></ul></ul><ul><ul><li>Differentiate between “reliever” and “controller” </li></ul></ul><ul><ul><li>Proper use of inhaler devices </li></ul></ul><ul><ul><li>Proper use of peak flow meter </li></ul></ul><ul><ul><li>Self management plan </li></ul></ul><ul><ul><li>Recognize features of worsening asthma </li></ul></ul><ul><ul><li>Dangers of non prescribed self medication </li></ul></ul>
    6. 10. Peak Flow Chart <ul><li>People with moderate or severe asthma should take readings: </li></ul><ul><ul><li>Every morning </li></ul></ul><ul><ul><li>Every evening </li></ul></ul><ul><ul><li>After an exacerbation </li></ul></ul><ul><ul><li>Before inhaling certain medications </li></ul></ul>Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI
    7. 11. CONTROLLER MEDICATIONS & THEIR SIDE EFFECTS
    8. 13. RELIEVERS MEDICATIONS & THEIR SIDE EFFECTS
    9. 14. 2. IDENTIFY & REDUCE EXPOSURE TO RISK FACTORS <ul><li>Factors that may precipitate asthma attacks: </li></ul><ul><ul><li>Indoor allergens: domestic mites, furred animal, cockroaches, and fungi. </li></ul></ul><ul><ul><li>Outdoor allergens: pollens and molds. </li></ul></ul><ul><ul><li>Smoking: active or passive </li></ul></ul><ul><ul><li>Atmospheric pollutants </li></ul></ul><ul><ul><li>Day-to-day triggers: exercise and cold air </li></ul></ul><ul><ul><li>Occupational exposure </li></ul></ul><ul><ul><li>Food & food additive </li></ul></ul><ul><ul><li>Drugs: aspirin, NSAIDs, and B-blocker </li></ul></ul><ul><ul><li>Others: obesity/ influenza vaccine/ emotional stress </li></ul></ul>
    10. 15. <ul><li>ASSESSING ASTHMA CONTROL: </li></ul><ul><ul><li>To establish patients’ current treatment regimen </li></ul></ul><ul><ul><li>Adherence to the current regimen </li></ul></ul><ul><ul><li>Level of asthma control </li></ul></ul><ul><li>TREATING TO ACHIEVE CONTROL </li></ul><ul><ul><li>Reliever and controller medications </li></ul></ul><ul><li>MONITORING TO MAINTAIN CONTROL </li></ul><ul><ul><li>Controlled  STEP DOWN </li></ul></ul><ul><ul><li>Loss of control  STEP UP </li></ul></ul>3. ASSESS, TREAT & MONITOR ASTHMA
    11. 16. a) Level of asthma control Three or more features of partly controlled asthma present in any week
    12. 18. c) Monitoring to maintain control <ul><li>Frequency of health care visit: </li></ul><ul><ul><li>1-3/12 after initial visit (dx) </li></ul></ul><ul><ul><li>every 3/12 thereafter </li></ul></ul><ul><ul><li>following exacerbation  follow up 2/52 to 1/12 </li></ul></ul><ul><li>Stepping down: </li></ul><ul><ul><li>low dose ICS as controller  switched to OD dose </li></ul></ul><ul><ul><li>medium/high dose ICS  ↓ 50% within 3/12 </li></ul></ul><ul><ul><li>ICS + LABA  ↓ ICS by 50% + continue LABA. Once control is maintained  ↓ ICS to low dose + stop LABA </li></ul></ul><ul><ul><li>ICS + controller other than LABA  ↓ ICS by 50% or low dose + stop the combination </li></ul></ul>
    13. 19. <ul><li>Stepping up: </li></ul><ul><ul><li>short acting B 2 agonist / LABA </li></ul></ul><ul><ul><li>ICS </li></ul></ul><ul><ul><li>combination: ICS + rapid and long acting B 2 agonist </li></ul></ul><ul><li>Difficult-to-treat asthma: </li></ul><ul><ul><li>definition: not reaching acceptable control at step 4 </li></ul></ul><ul><ul><li>confirm diagnosis </li></ul></ul><ul><ul><li>ensure compliance </li></ul></ul><ul><ul><li>proper technique of using inhalation devices </li></ul></ul><ul><ul><li>smoking </li></ul></ul><ul><ul><li>comorbidities: obesity / OSA / chronic sinusitis / GERD / psychological disorders </li></ul></ul><ul><ul><li>consider referral to respiratory physician </li></ul></ul>
    14. 20. 4. MANAGE EXACERBATION <ul><li>Aim of management: </li></ul><ul><ul><li>To prevent death </li></ul></ul><ul><ul><li>To relieve respiratory distress </li></ul></ul><ul><ul><li>To restore patient’s lung function to the best possible level as soon as possible </li></ul></ul><ul><ul><li>To prevent early relapse </li></ul></ul><ul><li>Assessment of severity of attack: </li></ul><ul><ul><li>Hx taking & physical examination </li></ul></ul><ul><ul><li>PEF measurement </li></ul></ul>
    15. 21. ASSESSMENT OF SEVERITY OF ASTHMA EXACERBATION FEATURES MILD MODERATE SEVERE / LIFE THREATENING ALTERED CONSCIOUSNESS NO NO YES PHYSICAL EXAMINATION NO NO YES SPEECH SENTENCES PHRASES WORD(S) PULSE RATE < 100 bpm 100-120 bpm > 10 bpm PULSUS PARADOXUS ABSENT ( < 10 mmHg) MAYBE PRESENT (10-25 mmHg) OFTEN PRESENT ( > 25 mmHg) WHEEZING INTENSITY MODERATE LOUD OFTEN QUITE USE OF ACCESSORY MUSCLE ABSENT MODERATE MARKED CENTRAL CYANOSIS ABSENT ABSENT PRESENT
    16. 22. CONTINUE.. FEATURES MILD MODERATE SEVERE / LIFE THREATENING <ul><li>PEFR </li></ul><ul><li>after initial use of bronchodilator or % predicted or % personal best </li></ul>> 80 % 60-80 % < 60 % O 2 SATURATION > 95 % 91-95 % < 90 % ARTERIAL PO 2 NO NEED TO DO ABG > 60 mmHg < 60 mmHg ARTERIAL PCO 2 NO NEED TO DO ABG < 45 mmHg > 45 mmHg
    17. 26. b) Pharmacology revisited.. BRONCHIAL TONE BRONCHOCONSTRICTION BRONCHODILATION ATP AC cAMP PDE AMP ADENOSINE ACETYLCHOLINE
    18. 27. b) Pharmacological treatment BRONCHIAL TONE BRONCHOCONSTRICTION BRONCHODILATION ATP AC cAMP PDE AMP B 2 AGONIST THEOPHYLLINE ADENOSINE ACETYLCHOLINE THEOPHYLLINE ANTI CHOLINERGIC

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