A chronic lung disorder that is marked by recurring
episodes of airway obstruction (as from
bronchospasm) manifested by laboured breathing
accompanied especially by wheezing and coughing
and by a sense of constriction in the chest, and
that is triggered by hyper reactivity to various
Asthma attacks all groups but often starts in
Characterized by recurrent attacks s of
breathlessness and wheezing, which has
different severity and frequency in each person.
Attack from hour to hour and day to day.
Figure 1: Lung anatomy
Pathway of respiratory system:
Nostrils nasopharynx oral
pharynx glottis trachea
right & left bronchi
Figure 2: Differrence between normal airway and airway in person with asthma
inner lining of
mucus due to
a) House dust mites
b) Exposure to tobacco smoke.
c) Predisposed to animals, pollens moulds and
Dietary changes – junk food and fast food
Lack of exercise - Less stretching of the
- Irritants in the workplace : chemicals, dusts,
gases, moulds and pollens. These can be
found in industries such as baking, spray
painting of cars, woodworking, chemical
production, and farming.
Atopic diseases – eczema and allergic rhinitis.
Maternal status – both physical and mental
conditions like anaemia and depression in the
mother are associated with asthmatic stress
for the child.
Early antibiotic use – babies who are given
antibiotics may be 50% more likely to develop
asthma by the age of six
Initial exam (conducted by doctor):
Asthma symptoms, how you feel, known
asthma and allergy triggers, your activity level
and diet, your home and work
environment, and family history.
Then, some tests will be conducted to
Peak Flow Meter
PEFR is used to assess the severity of wheezing in
those who have asthma. PEFR measures how quickly
a person can exhale air from the lungs
Peak expiratory flow rate (PEFR)
It measures how much air you can exhale.
FEV1(force expiratory volume) > 80% =
Confirms the presence of airway obstruction
and measure the degree of lung function
Monitor your response to asthma medications
A drop of liquid containing the allergen in placed
on your skin (generally forearms is used).
A small lance with a pinpoint is poked through
the liquid into the top layer of skin (prick test).
If you are allergic to the allergen, after about 2
minutes the skin begins to form a reaction
(red, slightly swollen, and itchy: it makes a hive).
The size of the hive is measured and recorded.
The larger the hive, the more likely it is that you
are allergic to the allergen tested.
If there are symptoms that may be caused by
another condition such as pneumonia, your
doctor may want to do a chest X-ray.
It also may help to clarify the problem if there
is problem with asthma treatment.
Common symptoms of asthma
1. Coughing, especially at night
3. Shortness of breath
4. Chest tightness, pain, or pressure
Mild asthma attack
3. Mild difficulty breathing during normal
4. Difficulty sleeping
6. Peak expiratory flow rate (PEFR) is 70 to 90%
of personal best
Moderate asthma attack
1. Severe cough
2. Moderate wheezing
3. Shortness of breath
4. Chest tightness
Usually worsens with exercise
5. Inability to sleep
6. Nasal congestion
7. PEFR is 50 to 70% of personal best
Severe asthma attack
1. Severe wheezing
2. Severe difficulty breathing
3. Inability to speak in complete sentences
Sentences are interrupted by breathing
4. Inability to lie down
5. Signs of severe difficulty breathing
Rib retractions: ribs are visible during each breath
Nasal flaring: nostrils open wide during each breath
Use of accessory muscles: neck muscles are prominent
during each breath
6. Chest pain
Sharp, chest pain when taking a breath, coughing
7. PEFR is <50% of personal best
9. Rapid pulse
11. Rapid breathing rate
It is triggered when you inhale one of the following
a) Tobacco smoke
b) Animal dander
c) Dust mites
Age onset over 40 y/o
Specific symptoms: runny nose, watery eyes, you are
wheezing more, SOB, swollen nasal passages, excess
mucus, and a scratchy throat. A cough may result from
the constant postnasal drip
Not triggered by allergens
Age onset under 40 y/o
Irritants- Tobacco smoke, wood smoke, room
deodorizers, fresh paint, household cleaning
products, cooking odours, workplace chemicals,
perfumes, and outdoor air pollution, heartburn,
changes in temperature.
Specific symptoms: Respiratory infections, such
as the common cold, Influenza or a sinus
When cough is the only asthma symptom,
this is known as cough variant asthma (CVA)
a) Chronic, non- productive cough
b) High sensitive cough reflex
A common respiratory condition that results from
exposures in the workplace
Examples of the occupations and the potential
a) Dental hygienists: latex
b) Bakers: flour
c) Roofers, insulators and painters: isocyanates
d) Welders and metal workers: metals: metals (nickel,
platinum and chromic acid)
e) Plastic manufacturers: glues and resins
f) Farmers and veterinarians: animal proteins
g) Carpenters: wood dust
Airway irritation, obstruction, and
Worsening after arriving at work and
improvement on weekends or during
extended periods away from work.
a) Engineering controls (such as improved
ventilation) to reduce or eliminate the
b) Use respiratory protective equipment
A type of asthma triggered by exercise or
SOB, chest tightness, and cough.
Symptoms may occur shortly after a brief
episode of exercise or 10 to 15 minutes into a
longer period of exercise.
The asthma getting worse because of medication
you take for another health condition.
a) Anti- inflammatories for aches and pain:
b) Heart disease drugs :inderal, coreg (beta-
c) Glaucoma drugs: beta-blockers eyes drop
d) Hypertension and congestive heart failure
drugs: angotensive converting enzyme
The chances of having asthma symptoms are
much higher during sleep because asthma is
powerfully influenced by the sleep-wake cycle
Causes : Exposure to allergens, cooling of the
airways, reclining position, hormone secretions
that follow a circadian pattern, heartburn at
Specific symptoms: wheezing, cough, and
trouble breathing are common and dangerous,
particularly at night time.
If my pregnancy shows no problems with
asthma, will labour be fine? –ASTHMATIC
No, you may have no signs of asthma attacks
during pregnancy, but then develop a sudden
attack during labour.
When asthma starts to develop?
mostly people develop asthma before ten y/o
Drugs Function Side effects
Reduce swelling and
mucus production in
Poor growth, decreased bone
density, varicella Infection
(chickenpox that spreads to
agonists (LABA) :
Open the airways and
(need to be used with
Increases severity of asthma
exacerbations and risk of fatal
Psychological reactions -
hallucinations, depression &
suicidal thinking/ headache,
Drugs Function Side effects
agonists (SABA) –
-Can be taken using
- Relax airway
nervousness, s inus
pain, sore throat,
Oral and intravenous
Same as inhaled
Changes asthma medications
from a liquid to a mist, so that
they can be more easily inhaled
into the lungs.
Drugs Function Side effects
Reduce symptoms in
people allergic to
dander, dust mites,
Redness, warmth at
the shot site, low
Omalizumab (Xolair). - Given as an injection
every two to four
weeks (for people who
- Altering the immune
Invasive procedure for severe asthma
Is not painful (no nerves inside airways)
Risks : mainly lung collapse, bleeding and additional
breathing problems, mostly related to the
Precaution: Pt. must be at least 18 y/o to have the
Pt. still need to use their asthma-maintenance
medications after the procedure
Benefits: Pt. may use rescue inhalers less often and are
able to engage strenuous physical activity than before
1. Diet : eat diets higher in vitamins C and E,
magnesium, and omega-3 fatty acids. Avoid
seafood that may become allergens.
2. Exercise: short, intermittent periods of
3. Stop smoking
1. Nurses, doctor, technicians, social workers,
therapists, and pharmacists
a) Pulmonologist: Do surgery for patient with
asthma that is difficult to control, exercise-
b) Allergist or immunologist :Allergen-triggered
c) Otolaryngologist : Nasal obstruction (e.g., from
polyps or sinusitis)
d) Mental health professional : Overcome social,
psychological, or psychiatric problems that
interfere with asthma treatment.
In mild-to-moderate cases, asthma can
improve over time, and many adults even
become symptom free.
For severe cases, improvement depending on
the degree of obstruction in the lungs and the
timeliness and effectiveness of treatment.
72% of men and 86% of women with asthma
had symptoms 15 years after an initial
diagnosis. Only 19% of these people, however,
were still seeing a doctor, and only 32% used
any maintenance medication.
Death from asthma is a relatively uncommon
event, and most asthma deaths are
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