Asthma

1. Centre for Physiotherapy and Rehabilitation Sciences
JAMIA MILLIA ISLAMIA
ASTHMA
submitted by;- hafiza Sania Urooj
Submitted to :-DR. Jamal ali moiz
Class:- bpt 4th year
Subject:- physiotherapy in cardiopulmonary condition (402)
Date of submission :- 05-01- 2021

2. Asthma
Introduction:-Asthma is defined as a chronic inflammatory disorder of the airways which manifests itself as
recurrent episodes of wheezing, breathlessness, chest tightness and cough. It is characterized by bronchial
hyper-responsiveness and variable airflow obstruction, that is often reversible either spontaneously or with
treatment.
• The prevalence of asthma in India is about 2%, and asthma is responsible for significant morbidity.
• Asthma develops primarily at a young age, but may also occur in adulthood. The prevalence of asthma is
about 10% in children and approximately 3% in adults .
• There are different type of asthma (called phenotype )
• Allergic asthma
• Nonallergic asthma
• Adult onset asthma
• Obesity asthma
• Air flow limitation asthma

3. Etiology and risk factor
• Asthma occur in families which suggest it is inherited disorder allergy is the predisposing factor for asthma
• Chronic exposures to airway irritant or allergenic also increases the risk for developing asthma .
• Common allergenic can be seasonal ( grass, tree, pollen )
• Excitatory state ( stress, cry)
• Occupational environments
• Other factor such as air pollution, cold air , infection
Triggers for an asthma attack :-
• Upper respiratory tract viral infections
• Exercise without warmup
• Cold air stress , irritant inhalation
• Medication ( beta – blocker )

5. Signs and Symptoms:-
• Wheeze
• Dry Cough:- Increased with Exercise Worse Early Morning/Night
• Chest Tightness, shortness of breath (SOB)
• Sputum (stringy, thick)
• Fatigue
• Runny Nose
• Headache
Clinical Features
• Hyperventilation/Increased Respiratory Rate ,Increased Work of Breathing
• Decreased Peak Expiratory Flow Rate
• FEV1
• FEV1/FVC
• Decreased PaO2 (partial pressure of oxygen in blood)
• Increased PaCO2 (partial pressure of carbon dioxide in blood)
• Increased Heart Rate

7. Investigations and Diagnosis
• Medical History
• Family History :-If the patient has a family history of asthma or allergies, they are more likely to also suffer
from asthmatic symptoms.
Physical Assessment
• Firstly, the patient’s nose, throat and upper airways will be examined for signs of asthma or allergies.
• Wheezing (high-pitched whistling sounds when the patient exhales)
• Coughing, chest tightness
• Shortness of breath (SOB)
• A runny nose
• Swollen nasal passages.
Diagnostic Tests:-
• The following tests are used to assess the patient’s breathing as well as to monitor the effectiveness of asthma
treatment.
• Lung function tests
Spirometry
Peak flow test

8. • Spirometry may be used to assess lung function by measuring the amount of expired air as well as the speed of
expiration.
• Peak flow testing
• Peak flow testing is a self-assessment lung function test using a peak flow meter to provide an objective
measure of airway function based upon peak expiratory flow rate (PEFR).
• Allergic test
• Blood test
• Chest X-ray
• Electrocardiogram (ECG)

9. Assessing the patient with asthma:-
• assess asthma control
• assess asthma risk factor
• Assess for comorbidities
• Assess treatment issue

12. • Assess for comorbidities :-
• rhinitis
• gastro-oesophageal reflux), assess comorbidities that may influence asthma outcomes
• depression or cognitive impairment, anxeity
• Obesity
• sleep apnoea

13. Management of asthma
• The goals of asthma treatment are to achieve good symptom control, maintain normal activity
levels, minimize future risk of exacerbations, and reduce adverse effects from medications.
Non-Pharmacologic Interventions :-
• Provide asthma education
• Basic facts about asthma
• How medication works
• Importance of taking daily controller medication Inhaler technique
• Environmental control measures
• Use of written action plan (symptom- and/or peak flow–based)
• Need for regular follow-up visits

14. Encourage patient self-management:-
• Take medication correctly
• Promote lifestyle interventions
• Encourage physical activity. Exercise has significant health benefits;
• exercise-induced asthma symptoms can be controlled, and engagement in regular exercise is
encouraged
• Encourage tobacco cessation.
• Encourage weight management.
Treat comorbid conditions that worsen asthma :-
• Allergic bronchopulmonary aspergillosis
• Environmental allergies
• Obesity
• Obstructive sleep apnoea
• Stress or depression
• Smoking

15. Pharmacological management :-
• Inhaled corticosteroid (ICS)
• ICS and Long-acting inhaled beta2-agonist (LABA), Combination ICS/LABA
• Leukotriene modifier
Physiotherapy treatment :-
• Three physiotherapy techniques breathing exercises, IMT and physical training techniques which are uses in
asthmatics.
1 Breathing exercise Techniques
Breathing Retraining Techniques
• The aim of breathing retraining is to normalize breathing patterns by stabilizing respiratory rate and increasing
expiratory airflow, pursed lip breathing technique advice .
Breathing retraining physiotherapy session :-
SESSION 1
Duration : 30-45 mints
Position :- patient should be comfortable sitting position and leg outstretched on a couch raised (45degree)
support with head and back .
Session 2 :-
Duration :- 30 to 40 mint

16. Position :- patient should be comfortable sitting or lying down position for relxatation exercise
Session 3
Duration :- 20 -30 mint
position ;- patient should be sitting position

17. 2. Inspiratory muscle training and asthma :-
• muscles can be trained for both strength and endurance . It is reasonable to suggest that increasing the strength
of the inspiratory muscles in people with asthma may reduce the intensity of dyspnea and improves exercise
tolerance.
• 2 -5 times a week over 3–8/12 weeks.
3. Physical training should be advised for improvements in fitness and cardiorespiratory performance in
patients with asthma.
Physical training should be advised to help reduce breathlessness and improve health-related quality of life in
people with asthma.
• duration :-150 minutes
• moderate-intensity physical activity throughout the week, or do at least 75 minutes of vigorous-intensity
physical activity throughout the week

18. Reference
• Physiotherapy in respiratory care unit ,alexander Hough third edition
• foetus, Patricia A.; Wise, Sarah K
• Rhizopodia
• . Bruton A, Thomas M.
• Global strategy for asthma management and prevention 2019 (GINA)
• Breathing exercise for asthma ,ESR publication