cover whole asthma treatmnt etc

1. By:
Samia Yaqoob Roll no. 15
Urooj Ilyas Roll no. 14

2.  Introduction (Etiology & Patho-physiology)
 Sign and Symptoms
 Acute & Severe Asthma
 Diagnosis
 Classification of Asthma & Its Treatment
 Management

3.  A disease affecting 7 to 10%of population
 More common in male children and female
adults
 Death rate is highest among blacks aged 15-24
years old
 The most common reason for death are
thought to be inadequate assessment for
severity of airways obstruction or inadequate
therapy with inhaled or oral steroids.

4.  A chronic inflammatory disorder of the
airways which occurs in susceptible
individuals , inflammatory symptoms are
usually associated with wide spread but
variable airflow obstruction and an increase
in airway response to a variety of stimuli.
Obstruction is often reversible either
spontaneously or with treatment.

5. Airways become smaller or
narrower, due to:
 Underlying inflammation or
swelling
 Increased mucus production
and
 Contraction of muscles
around the airways, or
bronchospasm

6.  The two main causes for asthma sypmtoms
are:
1: Airway hypersensitivity
2: Bronchoconstriction
 Although there is no single cause of asthma,
certain environmental and genetic factors are
known to contribute to the development of the
condition.

7. trigger examples
allergens Pollens, molds, house dust milds,
animal dander
Industrials chemicals Manufacture of isocyanate
containing paints, hair spray.
Penicillins, cimitidine
drugs beta blockers, aspirin, ibuprofen
and naproxen
foods shrimp, dried fruit, processed
potatoes, beer and wine, seafood
Environmental pollutants Traffic fumes, cigarette smoke
Miscellenious Cold air
Exercise
Emotions and stress
Respiratory infections, such as the
common cold

8.  Coughing, especially at night, during exercise or when
laughing.
 Shortness of breath.
 Chest tightness.
 Wheezing
 Any asthma symptom is serious and can become deadly
if left untreated.

9.  Extrinsic asthma :
o Develop in children with a history of atopy
o Allergens( dust , mite etc) cause IgE
production
 Intrinsic asthma:
o Develop in adulthood
o Non allergic factors might be the cause such
as viral infections, irritants, stress, exercise ,
triggering mediators released from mast cell

11.  If an acute attack becomes persistent and difficult to
treat, it is known as severe asthma
 It is a medical emergency that requires immediate
recognition and treatment.
 Patients with status asthmaticus have severe dyspnea
that has developed over hours to days.
 Frequently, these individuals have a previous history of
endotracheal intubation and mechanical ventilation,
frequent emergency department visits, and previous use
of systemic corticosteroids.

12.  The exact mechanism underlying the development of
an acute severe asthma attack remains elusive but there
appear to be two phenotypes:
 Gradual-onset - in about 80%, severe attacks develop
over more than 48 hours. These are associated with
eosinophilic infiltration and slow response to therapy.
 Sudden-onset - often in association with significant
allergen exposure. Patients tend to be older and to
present between midnight and 8 am. This type of attack
is associated with neutrophilic inflammation and a
swifter response to therapy.

13.  Shortness of breath may develop over hours or days
but is usually progressive rather than sudden.
 The patient will usually appear pink. Cyanosis is a
serious sign.
 Their respiratory rate is raised.
 Tachycardia is usual and may be increased by use of
beta2 agonists.
 chest appears hyper-inflated.
 In normal breathing, the ratio of the duration of
inspiration to expiration is about 1:2 but, as asthma
becomes more severe, the expiratory phase becomes
relatively more prolonged.
 Wheeze is usually expiratory, but may also be
inspiratory in more severe asthma.

14.  Initial assessment
 Take a very quick history and brief
examination (conscious level, colour, pulse,
blood pressure, respiratory rate, listening to
chest, )
 It might be :
 Mild or moderate
 Severe
 Life threatening

15. if a person presenting acute sever asthma but can
walk and speak whole sentences in one breath
 Immediately: Give 4–12 puffs salbutamol (100 mcg
per actuation) via pMDI plus spacer
 continue bronchodilator Any of: persisting dyspnoea,
inability to lie flat without dyspnoea,
 For poor response:add ipratropium bromide 8 puffs
(160 mcg) via pMDI (21 mcg/actuation)

16.  Within first hour: start systemic corticosteroids. Oral
prednisolone 37.5–50 mg then continue 5–10 days OR,
if oral route not possible Hydrocortisone 100 mg IV
every 6 hours
 (1 hour after starting bronchodilator) Perform
spirometry (if patient capable)
 After 1 hr if dyspnoea resolved : Advise/arrange
follow-up review

17.  Any of: unable to speak in sentences, visibly breathless,
increased work of breathing, oxygen saturation 90–
94%
 Give 12 puffs salbutamol (100 mcg per actuation) via
pMDI plus spacer OR Use intermittent nebulisation if
patient cannot breathe through spacer. Give 5 mg
nebule salbutamol. Drive nebuliser with air unless
oxygen needed Start oxygen (if oxygen saturation less
than 95%)

18.  For poor response
add ipratropium bromide 8 puffs (160 mcg) via pMDI
(21 mcg/actuation)
 Corticosteroids
 If sign remain unresolved continue bronchodilator, and
start IV sulbutamol in ICU
 Further deterioration in condition required ventilation
 Monitor arterial blood gas, oxygen saturation.

19.  Person either collapsed , cynocytic, exhausted or
oxygen saturation less than 90% , bradichardia shows
that he is suffering from life threatening asthma.
 Give sulbutamol (5mg) via continuous nubilization (5-
10mg/hr)
 Start suplimental oxygen
 In case of poor response within one hr give ipratropium
bromide(500mcg)
 After 1 hr start systemic corticosteroids( IV
hydrocortisone)
 Possible incubation and mechanical ventilation

20.  Continue treatment with inhaled SABAs
 Continue course of oral or systemic corticosteroids for
7 days
 Patient education
 Before discharge schedule follow-up appointment with
primary care provider or asthma specialist in 1-4 weeks

21.  Introduction (Etiology & Patho-physiology)
 Sign and Symptoms
 Acute & Severe Asthma
 Diagnosis
 Classification of Asthma & Its Treatment
 Management

22. Diagnosis

23. On follow-up visits:
 A medical history
i. Cough
ii. Breathing problem on doing physical activity
iii. Chest tightness
iv. Wheezing
v. Cold lasting time
vi. Family history
 Lung function test (Spirometer and Peak Flow meter)
 Check for allergies by skin testing and blood IgE antibody
test.

24. Classification of Asthma & its
treatment

25. a/c to asthma control
Controlled
Partly
controlled
Uncontrolled
a/c to severity
Intermittent
Mild
persistent
Moderate
persistent
Severe
persistent

26. Considered intermittent if without treatment any of the following are
true:
 Symptoms (dyspnea, wheezing, chest tightness, coughing)
◦ Occur on fewer than 2 days a week.
◦ Do not interfere with normal activities.
 Nighttime symptoms occur on fewer than 2 days a month.
 Lung function tests: FEV or PEF > or equal to 80%
 It is controlled type of asthma control.
 Treatment: SABA prn. e.g. albuterol (Ventolin)

27. Considered moderate persistent if without treatment any of the following are true:
 Symptoms:
o occur on more than 2 days a week but do not occur every day.
o Attacks interfere with daily activities.
 Nighttime symptoms occur 3 to 4 times a month.
 Lung function tests are normal, FEV or PEF > or equal to 80%.
 It is partly controlled type of asthma control.
 Treatment:
o 0-4 yrs age: Low dose ICS (Beclomethasone :Qvar) OR Montelukast. (Myteka)
o 5- 11 yrs age: Low dose ICS OR Cromolyn Na (Intal) , LTRA OR theophylline.
o Above 12 yrs age: Low dose ICS OR Cromolyn Na , LTRA OR
theophylline (Theo-Dur).

28. Considered moderate persistent if without treatment any of the
following are true:
 Symptoms
o occur daily, inhaled short-acting asthma medication is used
every day.
o Interfere with daily activities.
 Nighttime symptoms occur more than 1 time a week, but do
not happen every day.
 Lung function tests are abnormal, FEV OR PEF 60- 80 %.

29.  Treatment:
i. Treatment 1:
o 0-4 yrs age: Medium dose ICS
o 5-11 yrs age: Low dose ICS + LABA, LTRA or Theophylline or
Medium dose ICS
o Above 12 yrs: Low dose ICS+LABA or ICS
alternative Low dose ICS + LTRA, Theophylline or Zileuton.
ii. Treatment 2:
o 0-4 yrs age: Medium dose ICS +LABA Or Montelukast.
o 5-11yrs age: Medium dose ICS + LABA
alternative Medium dose ICS + LTRA or Theophylline
o Above 12 yrs age: Medium-dose ICS +LABA
alternative Medium dose ICS + LTRA, Theophylline or Zileuton.

30. Considered severe persistent if without treatment any of the
following are true:
 Symptoms:
◦ Occur throughout each day.
◦ Severely limit daily physical activities.
 Nighttime symptoms occur often, sometimes every night.
 Lung function tests are abnormal (60% or less of expected value),
and PEF varies more than 30% from morning to afternoon.

31.  Treatment:
i. Treatment 1:
o 0-4 yrs age: High dose ICS + LABA or Montelukast
o 5-11 yrs age: High dose ICS + LABA
alternative High dose ICS + LTRA or Theophylline
o 12 or above age: High dose ICS + LABA
alternative Omazulimab
ii. Treatment 2:
o 0- 4 yrs age: High dose ICS + Oral corticosteroids +LABA or Montelukast
o 5-11 yrs age: High dose ICS + LABA + Oral corticosteroids
alternative High dose ICS + LTRA or Theophylline + Oral corticosteroids
o 12 or above age: High dose ICS + LABA +Oral corticosteroids
alternative consider omazulimab.

32. Management