Asthma oct 2021 romani pptx
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Asthma lecture for English speaking students
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Asthma oct 2021 romani pptx
- 1. ASTHMA
- 2. CASE No 1 age: 66 • Dan B. Pascaru • HTA from age 45 – Amlodipine – Perindopril
- 3. Case No 1 • Stopped medication in sept 2018
- 4. CASE No 1 • Symptoms (2 days) – Coughing – Dyspneea • Signs: – Wheezing – Crackles
- 5. CASE No 1 • Symptoms (2 days) – Coughing – Dyspneea • Signs: –Wheezing – Crackles
- 6. DIAGNOSIS • ACUTE EXACERBATION OF ASTHMA ?
- 7. Laboratory Tests ? FIRST LINE SECOND LINE
- 8. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 9. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP = 12.000 SECOND LINE • Sputum examination
- 10. Beta2 mimetics ! prof • Tachycardia • Arrhytmias • Myocardial ischemia
- 11. Case No 2 age: 16 Melinda Pasca • History of asthma • 2 crisis at age of 14 • 2 crisis/year • No medication
- 12. Case No 2 Symptoms (2 hours) • tachypnea • acute shortness of breath • audible wheezing “I feel like a fish out of water” Signs: Wheezing HR 110, RR 40
- 13. DIAGNOSIS • ACUTE EXACERBATION OF ASTHMA ?
- 14. Laboratory Tests ? FIRST LINE SECOND LINE
- 15. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 16. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 17. Complete blood count • Hb=12,7 • WBC=7000 • Pl=230.000 • Eosinophil count=15% N=(1-4%) • ESR=14 mm (N=0-9mm) • CRP=N • Fbg=N
- 18. Paraclinical Tests FIRST LINE • EKG • Chest radiograph • Echocardiography SECOND LINE • Spirometry
- 19. Paraclinical Tests FIRST LINE • EKG • Chest radiograph • Echocardiography SECOND LINE • Spirometry
- 21. Laboratory Tests FIRST LINE • EKG • Chest radiograph • Echocardiography SECOND LINE • Spirometry
- 23. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 24. Arterial Blood Gases ? pH PaCO2 HCO3 - PaO2 (Slightly) pH= 7.5, PaCO2= 27, HCO3- =22 PaO2= 75
- 25. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP=120 SECOND LINE • Sputum examination
- 26. DIAGNOSIS: ASTHMA • Mild ? • Moderate ? • Severe ?
- 30. ASTHMA
- 31. DEFINITION Chronic or acute disease ?
- 32. DEFINITION • Common chronic disorder of the airways • Characterized by – Variable and recurring symptoms – Airflow obstruction – Bronchial hyperresponsiveness – And underlying inflamation
- 33. In a class of 30 students, you can expect 2 to 3 students WILL have asthma
- 34. Etiology • Extrinsic asthma – Allergic or atopic asthma • Intrinsic asthma – Nonallergic or nonatopic asthma
- 35. Anatomic Alterations of the Lungs • Smooth muscle constriction of bronchial airways (bronchospasm) • Excessive production of thick, whitish, tenacious bronchial secretions • Hyperinflation of alveoli (air-trapping) • Mucus plugging and, in severe cases, atelectasis
- 36. Figure 13-2. The immunologic mechanisms in asthma.
- 37. Intrinsic Asthma (Nonallergic or Nonatopic Asthma) • Infections • Exercise and cold air • Industrial pollutants or occupational exposure • Drugs, food additives, and food preservatives • Gastroesophageal reflux • Sleep (nocturnal asthma) • Emotional stress • Premenstrual asthma
- 39. Vital signs • Increased respiratory rate • Increased heart rate, cardiac output, blood pressure Clinical Data
- 40. Figure 2-12. Percussion becomes more hyperresonant with alveolar hyperinflation.
- 41. Figure 2-17. As air trapping and alveolar hyperinflation develop in obstructive lung diseases, breath sounds progressively diminish.
- 42. Chest assessment findings • Expiratory prolongation 1:3, 1:4 • Decreased tactile and vocal fremitus • Hyperesonant percussion • Diminished breath sounds • Diminished heart sounds • Wheezing and rhonchi Clinical Data
- 43. • General findings • Use of accessory muscles of inspiration • Use of accessory muscles of expiration • Pursed-lip breathing • Substernal intercostal retractions • Increased anteroposterior chest diameter (barrel chest) • Cyanosis • Cough and sputum production • Pulsus paradoxus ? Clinical Data
- 44. Pulsus paradoxus • Decreased blood pressure during inspiration • Increased blood pressure during expiration Clinical Data
- 45. Paradoxical pulse • = abnormally large decline in systolic arterial pressure during inspiration
- 46. NONPULMONARY MANIFESTATIONS • Signs of atopy or allergic rhinitis • Skin atopic dermatitis, eczema, or other manifestations of allergic skin conditions.
- 47. LABORATORY TESTS
- 48. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 49. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 50. COMPLETE BLOOD COUNT - Blood eosinophilia greater than 4% or 300-400/µL is consistent with the diagnosis of asthma, but - a normal value is not exclusionary.
- 51. - IgE >100 IU patients with allergic reactions - test for allergic sensitivity : - allergy skin tests (Prick test) - blood radioallergosorbent tests (RAST).
- 52. Paraclinical Tests FIRST LINE • EKG • Chest radiograph • Echocardiography SECOND LINE • Pulmonary Function Study
- 53. Paraclinical Tests FIRST LINE • EKG • Chest radiograph • Echocardiography SECOND LINE • Pulmonary Function Study
- 54. Radiologic Findings Chest radiograph • Normal • Hyperinflation – Increased anteroposterior diameter – Translucent (dark) lung fields – Depressed or flattened diaphragm
- 56. Laboratory Tests FIRST LINE • Complete blood count • EKG • Chest radiograph • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 57. ABG • pH=7,35-7,45 • paCO2=35-45mmHg • SaO2=93-98% • paO2=80-100mmHg • HCO3=24-26mEq/l
- 59. Arterial Blood Gases Mild to Moderate Asthma Episode Acute alveolar hyperventilation with hypoxemia pH PaCO2 HCO3 - PaO2 (Slightly)
- 61. Arterial Blood Gases Severe Asthmatic Episode (Status Asthmaticus) Acute ventilatory failure with hypoxemia pH PaCO2 HCO3 - PaO2 (Significantly)
- 62. Laboratory Tests FIRST LINE • Complete blood count • EKG • Chest radiograph • Arterial Blood Gases • BNP SECOND LINE • Pulmonary Function Study • Sputum examination ratio
- 65. NORMAL
- 66. OBSTRUCTION
- 69. Laboratory Tests FIRST LINE • Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 70. Sputum examination • Eosinophils • Charcot-Leyden crystals (see next slide) • Casts of mucus from small airways –called Kirschman spirals • IgE level (elevated in extrinsic asthma)
- 71. Charcot-Leyden Crystals Needle shaped crystals - Represents breakdown products of eosinophils
- 73. DIFFERENTIAL DIAGNOSIS ? • LEFT HEART FAILURE • COPD
- 74. HEART FAILURE
- 75. COPD
- 76. • Pulmonary Function Testing -the degree of reversibility in FEV1 which indicates a diagnosis of asthma is generally accepted as ≥ 12% and ≥ 200 ml from the pre-bronchodilator value the administration of a short-acting bronchodilator. PARACLINICAL EXAMINATIONS
- 77. Figure 9-10. Bronchospasm clinical scenario (e.g., asthma). ASTHMA
- 78. Figure 9-11. Excessive bronchial secretions clinical scenario. COPD
- 83. GINA FEV 1 > 80%
- 84. GINA FEV 1 > 80% FEV 1 > 80%
- 85. GINA FEV 1 =60- 80% FEV 1 > 80% FEV 1 > 80%
- 86. GINA FEV 1 =60- 80% FEV 1<60% FEV 1 > 80% FEV 1 > 80%
- 87. TREATMENT
- 88. 1. Wich of the folowing are clinical findings in asthma ? a) Wheezing b) Retrosternal thoracic Pain c) Diminished breath sounds at auscultation d) Decreased heart rate (bradycardia) e) Hepatomegaly, jugular distension and edema
- 89. 2. In asthma, laboratory tests show: a) Elevated BNP > 12.000 b) Increased anteroposterior diameter in X-ray c) Elevated pH in mild to moderate asthma d) restrictive respiratory disfunction in spirometry e) Thrombus in right pulmonary artery
- 90. 3. What is the treatment for acute asthmatic chrisis ? a) Symbicort 3-4 times a day b) Spiriva 1/day c) Salbutamol d) Oxygen e) Intravenous Amynophiline
- 91. TREATMENT
- 95. TREATMENT • 1 • 2 • 3 • 4 • 5 • 6
- 96. cromones R 1 2 3 4 5 IgE antagonist
- 97. CLASSIFICATION 3
- 98. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6 CLASIFICATION 3
- 99. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 100. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 102. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 103. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 105. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 106. Beta2 agonists • Short-acting • FENOTEROL • SALBUTAMOL • TERBUTALINE • Long-acting • FORMOTEROL • SALMETEROL 1 4 hours 12 hours
- 107. Beta2 agonists • Short-acting • FENOTEROL =BEROTEC • SALBUTAMOL =VENTOLIN • TERBUTALINE =BRYCANIL • Long-acting • FORMOTEROL=OXIS TURBUHALER • SALMETEROL=SEREVENT 1 4 hours SELECTIVES 12 hours
- 109. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 110. Anticholinergics • Short-acting • IPRATROPIUM BROMIDE • OXITROPIUM BROMIDE • Long-acting • TIOTROPIUM 2
- 111. Anticholinergics • Short-acting • IPRATROPIUM BROMIDE=IPRAVENT • OXITROPIUM BROMIDE=ATROVENT • Long-acting • TIOTROPIUM =SPIRIVA 2 24 hours 6 hours
- 112. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 113. Methylxantines • Short-acting • Aminophyline • Long-acting • Theophyline (SR) 3
- 114. Methylxantines • Short-acting • Aminophyline =MIOFILIN • Long-acting • Theophyline (SR) 3
- 116. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 117. Glucocorticosteroids • Systemic • Prednisone • Methyl-prednisolone • Inhaled • Beclomethasone • Budesonide • Fluticasone 4 HHC in acute form Long action
- 118. Glucocorticosteroids • Systemic • Prednisone • Methyl-prednisolone • Inhaled • Beclomethasone=BECOTIDE • Budesonide=PULMICORT • Fluticasone=FLIXOTIDE 4 HHC in acute form Long action
- 120. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 122. Phosphodiesterase-4inhibitors • Cromolyn =INTAL • Nedocromil=TILADE 5
- 123. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation and edema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 124. Leukotriene -inhibitors • Montelukast • Zafirlukast • Zileuton 6
- 125. Leukotriene -inhibitors • Montelukast =SINGULAIR • Zafirlukast=ACCOLATE • Zileuton=ZYFLO 1/day 2/day 4/day 6
- 127. COMBINATIONS – in one inhaler • Short-acting β 2 agonist plus anticholinergic FENOTEROL+IPRATROPIUM SALBUTAMOL+IPRATROPIUM • Long-acting β 2 agonist plusglucocorticosteroids FORMOTEROL+BUDESONIDE SALMETEROL+FLUTICASONE
- 128. COMBINATIONS – in one inhaler • Short-acting β 2 agonist plus anticholinergic FENOTEROL+IPRATROPIUM= BERODUAL SALBUTAMOL+IPRATROPIUM= COMBIVENT • Long-acting β 2 agonist plusglucocorticosteroids FORMOTEROL+BUDESONIDE= SYMBICORT SALMETEROL+FLUTICASONE= SERETIDE 25/50 25/125 25/250
- 131. ASTHMATIC CRISYS TREATMENT • ? • ? • ? • ? • ?
- 132. ASTHMATIC CRISIS TREATMENT • 1)Beta2 mimetics (VENTOLIN) • 2)ATROVENT (IPRATROPIUM BROMIDE) • 3)AMYNOPHILINE (Miofilin 1-1-1 inj//day) • 4) HHC 100mg (1-0-1 inj/day) • 5)______ • 6)______
- 133. ASTHMATIC CRISIS TREATMENT • Oxygen • Antibiotics : Ampiciline, Cefalosporines, Quinolones • Mucolitics: water, Acetilcisteine 3/day, Bromhexine. • Bicarbonate • ADRENALINE 0,3-0,5 ml • Prednisone 30-40 mg/day < 5 mg/5 days • Mechanical ventilation
- 134. CHRONICAL TREATMENT • 1)Long acting beta 2 mimetics: Serevent • 2)___________COPD • 3)Teotard • 4) inhaled glucosteroids: Becotide, Pulmocort, Flixotide • 5) Cromolyn, Nedocromil • 6)Leukotriene inhibitors: Singulair, zafirlukast, Zileuton
- 135. CLASSIFICATION 2
- 140. Beta2 mimetics ! • Tachycardia • Arrhytmias • Myocardial ischemia
- 141. OMALIZUMAB • Monoclonal antibody against IgE • Expensive and requires monthly injections • Most effective if allergies trigger asthma • Children with documented allegries • Not for children without allergies
- 144. cromones R 1 2 3 4 5 IgE antagonist
Editor's Notes
- We will start with 2 case presentations. I would like to see your information about asthma
- Sustain your clinical diagnosis
- I will tell you only the value of BNP and you will tell me if this is CF or Asthma
- Prin efectul beta 1
- His daughtert
- No signs on physical examiation
- Hyperpneea elimination of CO2 PaCO2=35-45 HCO#=24-27 PaO2>80 pH 7,35-7,45 RESPIRATORY ALCALOSIS greater than 110 indicates pt is on supplemental oxygen.
- What form ? There is a clasification of Asthma
- usually, the cough is nonproductive and nonparoxysmal. -children with nocturnal asthma tend to cough after midnight and during the early hours of morning.
- in the mildest form, wheezing is only end expiratory. in a more severe asthmatic episode, wheezing is also present during inspiration.
- Obtained at the Patient’s Bedside Other signs
- Severe asthma
- Total serum immunoglobulin E levels greater than 100 IU are frequently observed in patients with allergic reactions. Two methods are available to …to specific allergens in the environment
- -Gastroesophageal reflux - Obstruction of the upper airways and inhalation of foreign bodies - Dysfunction of the vocal cords - Non-obstructive pulmonary diseases (diffuse interstitial pneumopathy) - Pulmonary thromboembolism - Hyperventilation syndrome and panic attack.
- 1 nu este necesara medicatia de fond 2. De elective corticoizi-doza mica low 3. Treapta 3: corticoizi doza moderata sau corticoizi doza mica+ betaagonisti cu durata lunga de actiune; ca si alternative este:corticoizi cu antileucotriene sau corticoizi cu teofilina retard sau corticoizi cu anticolinergice cu durata lunga (tiotropium rec) 4. Corticoizi in doza mare+beta 2 agonisti cu durata lunga de actiune sau doza mare de corticoizi sau antileucotriene sau teofilina sau anticolinergice
- Neselective: adrenalina alfa=beta, isoprenalina beta1 si beta2 Selective-cele enumerate beta2>> beta1 BEROTEC VENTOLIN BRYCANIL REMINDER: Bronchodilators relieve symptoms but cannot reduce or prevent the swelling of airways that cause the symptoms. Debutul efectului la 5 minute dureaza 4 ore 4 doze/zi. OXIS TURBUHALER SEREVENT Debutul efectului la 3 ore dureaza 12 ore nu in acut ci in tratamentul cronic si profilaxia crizelor de astm ex: astmul indus de effort.
- Neselective: adrenalina alfa=beta, isoprenalina beta1 si beta2 Selective-cele enumerate beta2>> beta1 BEROTEC VENTOLIN BRYCANIL REMINDER: Bronchodilators relieve symptoms but cannot reduce or prevent the swelling of airways that cause the symptoms. Debutul efectului la 5 minute dureaza 4 ore 4 doze/zi. OXIS TURBUHALER SEREVENT Debutul efectului la 3 ore dureaza 12 ore nu in acut ci in tratamentul cronic si profilaxia crizelor de astm ex: astmul indus de effort.
- IPRAVENT=ipatropium bromide ATROVENT Efect in 15 minute, durata 6 ore SPIRIVA 24 ore deci nu se foloseste in urgenta
- IPRAVENT=ipatropium bromide ATROVENT Efect in 15 minute, durata 6 ore SPIRIVA 24 ore deci nu se foloseste in urgenta
- 200 mg de 2 ori/ zi la copii si adolescenti 350 mg Theotard de 2 ori/zi
- 200 mg de 2 ori/ zi la copii si adolescenti 350 mg Theotard de 2 ori/zi
- BECOTIDE PULMICORT FLIXOTIDE Doar pt tratament de intretinere Oral:are used for short-term treatment (3-10 d) to gain prompt control of inadequately controlled acute asthmatic episodes. I.V. corticosteroids are used in the acute phase of asthma.
- BECOTIDE PULMICORT FLIXOTIDE Doar pt tratament de intretinere Oral:are used for short-term treatment (3-10 d) to gain prompt control of inadequately controlled acute asthmatic episodes. I.V. corticosteroids are used in the acute phase of asthma.
- INTAL TILADE
- INTAL TILADE
- SINGULAIR 1/zi oraly ACCOLATE 2/zi oraly Zyflo 4/zi oraly
- SINGULAIR 1/zi oraly ACCOLATE 2/zi oraly Zyflo 4/zi oraly
- Nu sunt cu durata lunga beta2 si anticolinergic SERETIDE25/50 microgr 25/125 microgr 25/250 microgr Cele long-acting nu sunt eficiente in acut
- Nu sunt cu durata lunga beta2 si anticolinergic SERETIDE25/50 microgr 25/125 microgr 25/250 microgr Cele long-acting nu sunt eficiente in acut
- Prin efectul beta 1
- 1 nu este necesara medicatia de fond 2. De elective corticoizi-doza mica low 3. Treapta 3: corticoizi doza moderata sau corticoizi doza mica+ betaagonisti cu durata lunga de actiune; ca si alternative este:corticoizi cu antileucotriene sau corticoizi cu teofilina retard sau corticoizi cu anticolinergice cu durata lunga (tiotropium rec) 4. Corticoizi in doza mare+beta 2 agonisti cu durata lunga de actiune sau doza mare de corticoizi sau antileucotriene sau teofilina sau anticolinergice
- You must know that asthmatics can play sports There are many asthmatics players: David Backhamp
- And don’t forget Mark Spitz who won 7 gold medals in swimming in the same Olimpics who was also asthmatic.