ASTHMA PREPARED BY ENDLA SRINIVASA RAO

1. ASTHMA

2. Asthma is disease that affects the lungs. It causes
repeated episode of wheezing, breathlessness ,
chesttightness, and night time or morning
coughing. If someone has asthma, he or she it all
the times , but asthma attacks will occur only
when something bother the lungs. We know that
if some one in the family of person with asthma,
other family members are more likely to have it
too. In most causes we don’t’ know what cause
asthma, we don’t know how to cure. However it
can be controlled.

3. Asthma is a chronic inflammatory disorder of the
airway. In susceptible individual, inflammatory symptoms
are usually associated with widespread but variable airflow
obstruction and an increase in airway response to a variety
stimuli. Obstruction is often reversible either spontaneously or
with treatment.
British thorax society 2003

4. Asthma affects on estimated
25,000,000 Indians every year and this
number is likely to increase by 50% of
the year 2016. COPD and asthma
accounts nearly 15% of total diseases
burden in the country.

6. Asthma can be classified many types:
According to the frequency of symptoms, forced
expiratory flow rate. asthma may be classified as
 Extrinsic or Atopic
 Intrinsic or Non Atopic
Another classification of asthma
 Brittle asthma
Asthma attack
Status asthmaticus
Exercise induce asthma
Occupational Asthma

7. Classification depends on clinical
severity and duration of disease course
 Mild intermittent
Mild persistent
Moderate persistent
Severe persistent

8. Allergens : e.g. animal dander, pollen
molds house dust mites
Genetic factors
Exercises
Respiratory infection : e.g.sinuitis
Nose and sinus problem
Drugs and food additives
Gastro esophageal reflex diseases
Emotional stress
Occupational exspsure

9. House-dust mites which live in carpets,
mattresses and upholstered furniture
Some allergens which may cause asthma
Plant pollen
Dust of
book
depo-
sitories
Pharmacologi
cal agents
(enzymes,
antibiotics,
vaccines,
serums)
Spittle, excrements,
hair and fur
of domestic
animals
Food
components
(stabilizers,
genetically modified
products)

10. Asthma pathophysiology
is quite difficult and insufficiently
studied. Undoubtedly, in most cases the
disease is based on 1 type
hypersensitivity reaction. The genesis
of any allergic reaction may be divided
into immune, pathochemical and
pathophysio-logic phases.

11. T-cell
B-cell
After involving into the airways allergens
activate immunocompetent cells. As a result B-lymphocytes
produce antibodies of Ig E class. In case of asthma T-
lymphocytes are inhibited, so the activation of B-lympocytes
and Ig E production are excessive, exceeding normal needs.

12. Further these antibodies bind to the surface of mast
cells, basophils and eosinophils of bronchial mucous.
When a new portion of allergen involves the respiratory
system, it interacts with IgE-antibodies.
This is a first,
immune
phase of
allergic
reaction.

13. As a result of antigen-antibody reaction the
peculiar “explosion” occurs. The membranes of
mast cells, basophils and eosinophils of bronchial
mucous wreck with output of biologically active
substances (histamine, serotonin, chemotaxis
factors, heparin, proteases, thromboxane,
leukotrienes, prostaglandins),
which induce hyperergic
inflammation, mucous edema,
spasm of smooth myocytes,
glands hypersecretion, viscous
exudate formation in bronchial
lumen.

14. Itching on the neck
Dry cough at night or with exercise
Wheezing
Breathlessness
Cough productive or non productive
Mucosal edema
Mucus production and thick secretions
Sudden shortness breath
Increased respiratory rate
Increased pulse rate
Increase blood pressure
Chest tightness
Nasal flaring
Lung hyperinflation
Barrel chest

15. Decrease breath sounds
Lethargy
Cyanosis
Respiratory alkalosis
Status asthmaticus

16. History
Physical examination
Blood tests
Eosinophilia, moderate leukocytosis in
blood count as well as increased serum level of Ig E
can be found in patients with asthma, especially at
asthma exacerbations.
Inflammatory cells, Curschmann's spirals
(viscous mucus which copies small bronchi) and
Charcot-Leyden crystals (crystallized enzymes of
eosinophils and mast cells) can be observed in
sputum.

17. Sputum culture
Chest X-ray reveals:
hyperlucency of lung
fields
low standing and
limited
mobility of diaphragm
expanded intercostal
spaces
 horizontal rib position.

18. especially in case of severe,
persistent asthma, shows
hypertrophy of right heart
chambers.

19. Typical clinical
manifestations and
lung function
assessment are
sufficient for
diagnosis of asthma.

20. Peak expiratory flow (PEF)
Inexpensive
Patients can use at home
May be helpful for patients with severe disease to monitor
their change from baseline every day
Not recommended for all patients with mild or moderate
disease to use every day at home
Effort and technique dependent
Should not be used to make diagnosis of asthma

21. Spirometry
Recommended to do spirometry pre- and post- use of an
albuterol MDI to establish reversibility of airflow obstruction
Lung function assessment
The diagnosis and severity assessment of asthma is
based mainly on parameters of lung function. The most
important of them are:
forced expiratory volume
in 1 second (FEV1) and peak
expiratory flow (PEF), which
are measured during
spirometry at forced
breathing-out.

22. Control chronic and nocturnal symptoms
Maintain normal activity, including
exercise
Prevent acute episodes of asthma
Minimize ER visits and hospitalizations
Minimize need for reliever medications
Maintain near-normal pulmonary
function
Avoid adverse effects of asthma
medications

23. Global Initiative for Asthma (GINA) 6-point
plan
 Educate patients to develop a partnership in
asthma management
 Assess and monitor asthma severity with symptom
reports and measures of lung function as much as
possible
 Avoid exposure to risk factors
 Establish medication plans for chronic
management in children and adults
 Establish individual plans for managing
exacerbations
 Provide regular follow-up care

24. includes:
1. Avoiding the contact with allergen. If it is
impossible, the specific hyposensitization with
standard allergens should be performed. It is
rather effective in case of monoallergy, in
intermittent and mild persistent asthma, in
remission phase.
2. Elimination of trigger factors (rational job
placement, changing the residence, psychological
and physical adaptation, careful drug using) is
the second condition for successful asthma
treatment.
3. Optimally selected medical care is the base
of asthma management.

25.  bronchodilator : e.g. theophylline,
aminophylline.
Beta adrenergic agonists : e.g.
aibuterol, epinephrine
Corticosteroids : e.g. prednisone ,
hydrocortisone.
Mast cell stabilizer :cromolyn, nedocromil
.Anticholinergic drugs

26. Rib fractures
Pneumothorax
Pneumomediastinum
Atelectasis
Pneumonia
Status Asthmatics.

27. In case of early detection and adequate
treatment the prognosis for the disease
is favourable.
It becomes serious in severe persistent
and poorly controlled (insensitive for
corticosteroids) asthma.

28. Ineffective breathing pattern related to shortness of breath,
mucus, bronchoconstriction, and airway irritants.
Self-care deficits related to fatigue secondary to increased
work of breathing and insufficient ventilation and
oxygenation.
Activity intolerance due to fatigue, hypoxemia, and
ineffective breathing patterns.
Ineffective coping related to reduced socialization, anxiety,
depression, lower activity level, and the inability to work.
Deficient knowledge about self-management to be
performed at home.

29. According to epidemiological studies
asthma affects 1-18% of population of
different countries.
Only in 2006 more than 300
million patients suffered from asthma all
over the world, 250 thousands of patients
die of asthma. The incidence of asthma is
higher in countries with increased air
pollution.

30. Most common chronic condition in children
#1 cause of school absenteeism
Death rate up 50% from 1980 to 2000
Death rate up 80% in people under 19
Morbidity and mortality highly correlated with
Poverty, urban air quality, indoor allergens, lack of
patient education, and inadequate medical care
About 5000 deaths annually