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Asthma, Medicine, Notes, Lecture

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  1. 1. ASTHMA Sarang Suresh Hotchandani Final Year Bachelor in Dental Surgery (BDS) Student @ Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, Pakistan
  2. 2. INTRODUCTION • It is obstructive pulmonary disease. • Defined as chronic inflammatory disorder of airways characterized by airway hyper responsiveness and airflow obstruction leading to recurrent episodes of coughing, wheezing, breathlessness & chest tightness…
  3. 3. ETIOLOGY 1) Airway Hyperactivity • It is tendency of airway to narrow in response to triggers that have little or no effect in normal individuals. • Causes of airway hyperactivity • Airway inflammation • Degree of airway narrowing • Neurogenic mechanisms
  4. 4. ETIOLOGY cont’d 2) Atopy/Allergy •Atopy is defined as ability to rapidly produce IgG against materials.
  5. 5. COMMON ALLERGENS Indoor and outdoor allergy Microbial exposure Diet Breast feeding Vitamins Pets House dust Fungi Weather change Drugs  Aspirin & B-Blocker (Propranolol) Exercise
  6. 6. PATHOPSIOLOGY •Inhalation of an allergen into airway is followed by early & late Broncho constrictor response.
  7. 7. EARLY OR IMMEDIATE BRONCHO CONSTRICTOR RESPONSE • Occurs shortly after exposure to allergen within first 15 min - 1hour. • Caused by mediators of immediate hypersensitivity reaction; mast cells/basophils, release mediators and causes inflammation that leads to airway hyperactivity.
  8. 8. LATE BRONCHO CONSTRICTOR RESPONSE • Occurs late after exposure to allergen about 4-6 hours after. • Caused by influx of inflammatory cells and then releasing mediators which causes inflammation which leads to airway hyperactivity.
  9. 9. NOTE... NSAIDS release leukotrienes which causes asthma. Exercise cause loss of water from respiratory mucosa due to hyperventilation which triggers mediator release.
  10. 10. Remodeling of airway Fixed narrowing of airway Fibrosis COMPLICATIONS OF ASTHMA
  12. 12. • Daily, Throughout Day • Asthma Attack Daily • Not Throughout Day • Greater Than 2 Days/Week • Not Daily • Asthma Attack • Less Than 2 Days/Week Intermittent Mild Persistent Sever Persistent Moderate Persistent
  15. 15. • Clinical History • Demonstration of airflow obstruction by using spirometry or peak flow meter. • If • FEV ≥15% increases after administration of bronchodilator, Asthma is present. • > 20% diurnal variation on ≥ 3 days in week for 2 weeks on PEF, Asthma is present. • FEV ≥ 15% decrease after 6 min exercise, Asthma is present.
  16. 16. OTHER INVESTIGATIONS • Measurement of allergic status • Presence of atopy by skin prick test • Measurement of Ig E • FBC, for eosinophilia • Radiological exam • CXR often normal or show hyperinflation of lung.
  17. 17. MANAGEMENT •STEP 1 •STEP 2 •STEP 3 •STEP 4 •STEP 5
  18. 18. STEP 1 •Occasional use of inhaled short acting B2 – adrenal receptor agonist bronchodilators • E.g. Salbutamol, Terbutaline (in mild intermittent asthma)
  19. 19. STEP 2 Anti inflammatory Therapy Inhaled short acting beta agonist Asthma Control Anti inflammatory = Inhaled corticosteroids; Budesonide, Fluticasone & Baclometason
  20. 20. STEP 3 (add on Therapy) • Change short acting beta agonist with long acting beta agonist(LABA). Inhaled Corticosteroids Long Acting Beta agonists
  21. 21. STEP 4 (Addition of 4th Drug) • Used in those whose poor control on moderate dose of inhaled corticosteroid & LABA. • Discontinue the LABA from ICS and give any of following.
  22. 22. STEP 5 • continues use of oral steroids for control of symptoms • Osteoporosis caused by corticosteroid can be prevented by giving bisphosphonates. • In atopic Patients, omalizumab (monoclonal antibody directed against I g E. • Note: once asthma is controlled slowly reduce dose of corticosteroids.
  23. 23. EXACERBATION OF ASTHMA causes •Viral and fungal infection •Pollens •Air pollution
  24. 24. Management of MILD to MODERATE Asthma •Short course of rescue oral corticosteroid •(Prednisolone 30-60 mg daily)
  25. 25. Management of STATUS ASTHAMATICUS (Features) •PEF = 33-50% •Respiratory Rate ≥ 25 breaths/minute •Heart rate ≥ 110 beats/minute •Inability to complete sentence in one breath
  26. 26. TREATMENT OF STATUS ASTHAMATICUS • Oxygenation (O2 saturation should be > 92%) • High dose inhaled bronchodilators • SHORT ACTING B2 AGONIST ARE DRUG OF CHOICE • Salbutamol • Ipratropium bromide • Systemic corticosteroids • Orally; Prednisolone • IV; Hydrocostisone Still No Response…. Go for INTUBATION
  27. 27. Give me your precious feedback on Twitter @hotchandaniss