Bronchial asthma.vikramppt


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Bronchial asthma.vikramppt

  1. 1. BRONCHIAL ASTHMA Presented By Dr.N.Vikram.
  2. 2. CLINICAL FEATURES OF BRONCHIAL ASTHMA: <ul><li>Asthma is not a uniform disease but a Dynamic clinical syndrome. </li></ul><ul><li>CHARACTERISTIC SYMPTOMS: </li></ul><ul><li>Recurrent episodes of Wheezing </li></ul><ul><li>Chest tightness </li></ul><ul><li>Breathlessness </li></ul><ul><li>Cough. </li></ul>
  3. 3. <ul><li>Symptoms may worsen at night and pt’s typically awake in early morning hours. </li></ul><ul><li>Pt may report Difficulty in filling their lungs with Air. </li></ul><ul><li>In some pt’s there is increased Mucus production with typically Tenacious Mucus i.e.,Difficulty to expectorate. </li></ul><ul><li>Increased ventilation and use of accessory muscles of ventilation. </li></ul>
  4. 4. <ul><li>COMMON PRECIPITANTS: </li></ul><ul><li>Triggers: </li></ul><ul><li>Allergens, </li></ul><ul><li>Exercise, </li></ul><ul><li>Cold Air, </li></ul><ul><li>So2, </li></ul><ul><li>Particulates, </li></ul><ul><li>Viral Upper Respiratory Tract Infections. </li></ul>
  5. 5. <ul><li>PRODROMAL SYMPTOMS: </li></ul><ul><li>Itching under the chin, </li></ul><ul><li>Discomfort b/n the Scapulae, </li></ul><ul><li>Inexplicable Fear.[Impending Doom.] </li></ul><ul><li>In children Dominant symptom is </li></ul><ul><li>“ Wheeze” /”Breathlessness” may lead to </li></ul><ul><li>Non Productive Cough.[Cough Variant Asthma.] </li></ul><ul><li>TYPICAL PHYSICAL SIGNS: </li></ul><ul><li>Are inspiratory and to a great extent expiratory </li></ul><ul><li>“ Rhonchi” throughout the chest and “Hyperinflation.” </li></ul>
  6. 6. <ul><li>In some circumstances use of medications like B-adrenoreceptor antagonists [B-blockers] when administered topically as eye drops may induce Bronchospasm. </li></ul><ul><li>Aspirin an other NSAID’S are associated with asthma in 10 %of pt’s. </li></ul><ul><li>Aspirin –sensitive Asthma is often associated with “Rhinosinusitis” and “Nasal polyps.” </li></ul>
  7. 7. <ul><li>Occupational asthma is now the most common form of occupational respiratory disorder and accounts for 5 % of all adult onset asthma. </li></ul><ul><li>Eg; symptoms Improve during Day time away from work ,i.e., weekends/holidays. </li></ul><ul><li>Atopic individuals and smokers appear to be increased risk. </li></ul><ul><li>Early diagnosis and removal from exposure leads to a significantly improved prognosis and mat result in cure. </li></ul>
  8. 8. <ul><ul><ul><li>DIAGNOSIS: </li></ul></ul></ul><ul><ul><ul><li>1.PULMONARY FUNCTION TESTS : </li></ul></ul></ul><ul><ul><ul><li>Ideally pt should be instructed to record Peak Flow Readings after rising in the morning and before retiring in the evening. </li></ul></ul></ul><ul><ul><ul><li>Simple spirometry : </li></ul></ul></ul><ul><ul><ul><li>confirms airflow limitation with a reduced FEV1, FEV1/FVC. 15 minutes after an Inhaled short acting B2- agonist in some pt’s by 2 to 4 weeks trial of oral corticosteriods. [Prednisone/Prednisolone] 30-40mg daily. </li></ul></ul></ul>
  9. 9. <ul><li>Measurement of PEF twice daily may confirm the Diurnal variatons in airflow obstruction. </li></ul><ul><li>Flow volume loops show decrease peak flow and increase max expiratory flow. </li></ul><ul><li>“ Whole Blood Plethysmography” shows increased airway resistance and show increased total lung capacity and residual volume. </li></ul>
  10. 10. <ul><li>2.AIRWAY RESISTANCE: </li></ul><ul><li>Increase AHR is normally measured by Methacholine /Histamine challenge with calculation of Provocative concentration that decrease FEV1 by 20 %[pc20.] </li></ul><ul><li>But this is rarely useful in clinical practise ,but used in differential diagnosis of a chronic cough and when the diagnosis is in the doubt in the setting of normal pulmonary function tests. </li></ul>
  11. 11. <ul><li>3.HEMATOLOGIC TESTS: </li></ul><ul><li>Are not usually helpful ,but total serum IgE and specific IgE is Increased in Atopic Asthma to inhaled allergens.[Radio AllergoSorbentTest] may be measured in some pt’s . </li></ul><ul><li>4.IMAGING: </li></ul><ul><li>ON CHEST ROENTGENOGRAPHY: </li></ul><ul><li>It is usually normal but in more severe pt’s may show “Hyperinflated Lungs”.In exacerbations there may be a evidence of a “Pneumothorax.” </li></ul>
  12. 12. <ul><li>1 Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side. </li></ul>
  13. 13. <ul><li>2.A.plasia.. </li></ul><ul><li>Chest x-ray revealed complete opacification of left hemithorax with hyperinflation of the right lung and herniation with shifting of the mediastinum to the left lung </li></ul>
  14. 14. <ul><li>Lung shadows usually indicates Pneumonia /eosinophilic infiltrates in pt’s with Broncho pulmonary Aspegillosis. </li></ul><ul><li>5.ON HIGH RESOLUTION CT SCAN: </li></ul><ul><li>May show Areas of Bronchiectasis in pt’s with severe Asthma and there may be </li></ul><ul><li>“ Thickening of the Bronchial Walls”, but </li></ul><ul><li>these changes are not diagnostic of asthma. </li></ul>
  15. 15. <ul><li>7.EXHALED NITRIC OXIDE: </li></ul><ul><li>It is now being used as a Non-Invasive test to measure Eosinophilic Airway Inflammation. </li></ul><ul><li>Typical Elevated levels in Asthma are reduced by ICS, so this may be a test of Compliance with therapy. </li></ul><ul><li>And useful in Demonstrating Insufficient Anti –inflammatory therapy. </li></ul>
  16. 16. <ul><li>DIFFERENTIAL DIAGNOSIS: </li></ul><ul><li>Upper Airway Obstruction by a Tumour/Laryngeal oedema can mimic severe Asthma but pt’s typically presnt with Stridor localised to large airways. </li></ul><ul><li>Diagnosis is confirmed by Flow –volume loop that shows decrease in Inspiratory,Expiratory flow and bronchoscopy to demonstrate the site of Upper Airway Narrowing. </li></ul><ul><li>LVF may mimick the Wheezing of Asthma but Basilar Crackles are present in contrast to Asthma. </li></ul>
  17. 17. <ul><li>Eoisnophilic pneumonias and sytemic vasculitis including “CHURG STAUSS SYNDROME” and “PAN” may be associated with Wheezing . </li></ul><ul><li>COPD is usually easy to differentiate from Asthma as symptoms shows less Viability ,never completely remit, show much less reversibility to Bronchodilators. </li></ul>
  18. 18. <ul><li>THANK YOU </li></ul>