• 20 yrs old male ,nonsmoker, normotensive, euglycemic presented with
• Chief c/o : Acute onset of dyspnea and cough with scanty sputum production X 2 d
• No H/o fever but however h/o wheezing and chest tightness is present.
• No H/o PND, chest pain, hemoptysis
• Symptoms appeared after he went to visit his friend ,while playing with his dog.
• Similar episodes was present 1 year back. Running nose ,sneezing and rashes were
• Family history present .
• Patient became asymptomatic after use of some inhalers.
Pratap Sagar Tiwari
MD, Lecturer, NMC
AN INTRODUCTION TO ASTHMA
• Asthma is a syndrome characterized by airflow limitation/obstruction that varies markedly
, both spontaneously and with treatment.
• There is a hyperresponsiveness to a wide range of triggers leading to excessive
narrowing with consequent decrease in airflow and symptomatic wheezing and dyspnea.
• Note: Airway hyper-reactivity (AHR)-the tendency for airways to contract too easily and
too much in response to triggers that have little or no effect in normal individuals.
• The "classic" signs and symptoms of asthma are intermittent dyspnea, cough, and
It is the genetic predisposition to develop specific IgE antibodies directed against
It is the strongest identifiable risk factor for asthma.
Trigger includes pollen, fungal spores, food containing nuts, air pollution, cold air, laughter,
• Lower level of infection in childhood may be a factor related to increase risk of asthma.
• The HH proposes that lack of infection in early childhood preserves the TH2 bias.
• Exposure to infection result in shift towards predominant protective Th1 immune
MAKING A DIAGNOSIS
• Compatible clinical features
• Precipitating factors
• Family history
• Reversibility of symptoms/response to bronchodilators
ASTHMA VS COPD
• -- Not always productive cough
• -- Usually reversible
• -- Often associated with allergies
• -- Cough at night and early mornings
• -Family history
• -- Cough is usually productive
• -- Symptoms not reversible
• -- Common history of smoking
• -- Cough in morning and throughout the day.
• -- Age
Note: The diagnosis of asthma is predominantly clinical and based on a characteristic history.
A trial of corticosteroids: e.g. 30 mg daily for 2 weeks
Ref: GINA guideline
Pic taken from: http://upload.wikimedia.org/wikipedia/commons/f/f7/Peak_flow_meter_horiz.jpg
• COPD affects both the airways and the parenchyma, whilst asthma affects only the
• The nature of inflammation in Asthma is primarily eosinophilic and CD4-driven .In COPD it
is neutrophilic and CD8-driven .
• For asthma, severity is based on symptom frequency and severity, lung function but for
COPD, the stages of severity are defined by lung function.
• Homework: Management of Acute severe Asthma
• Harrison 18th ed .
• Uptodate 19.2
• GINA guidelines