This document provides an overview of asthma, including its definition, characteristics, classification, pathophysiology, symptoms, diagnosis, treatment approaches, and medications. Asthma is defined as a chronic inflammatory airway disorder characterized by bronchial hyperresponsiveness and reversible airway obstruction. It is classified as extrinsic, intrinsic, or mixed. Diagnosis involves assessing history, symptoms, and lung function tests. Treatment follows a stepwise approach starting with short-acting bronchodilators and inhaled corticosteroids, adding additional controllers as needed. Status asthmaticus refers to an acute, severe exacerbation unresponsive to usual treatment.

1. WELCOME

2. ANTIASTHMATICSPresented byP.Pavani10T22SO112 Under The Guidence of Mr. J. Anoop

3. ..Definition:Asthma is a chronic inflammatory disorder of the airways that is characterized by increased responsiveness of the tracheobranchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of the air passages which may be relieved spontaneously or therapy. Asthma literally meaning ‘Panting’Characteristics of Asthma:Inflammation of airways

4. Bronchial hyper-reactivity/hyper-responsivness

5. Reversible airway obstructionCLASSIFICATION OF ASTHMA:Based on the stimuli initiating bronchial asthma,broad etiologic types are described:Extrinsic(allergic, atopic) asthma Intrinsic(idiosyncratic,non-atopic) asthma Mixed type

6. PATHOPHYSIOLOGY:

7. MORPHOLOGICAL FEATURES: 1.The mucus plugs contain normal or degenerated respiratory epithelium forming twisted strips called “Curschmann’ssprials”. 2.The sputum usually contains numerous eosinophils and diamond-shaped crystals derived from eosinophils called “Charcot-Leyden crystals”. 3. Airway remodeling.

8. Symptoms: Early Warning SignsBreathing changes Sneezing Runny/stuffy nose Coughing Chin or throat itches Feeling tired Dark circles under eyes Trouble sleeping Asthma Episode SymptomsWheezing Shortness of breath Tightness in the chest

9. Severe Asthma Episode Symptoms personal Severe coughing, wheezing, Shortness of breath or tightness in the chest Difficulty talking or concentrating Walking causes shortness of breath Breathing may be shallow and fast or slower than usual Hunched shoulders (posturing) Nasal flaring Retractions Cyanosis.

10. Asthma Diagnosis:The diagnosis of asthma is based on:History

11. Physical examination

12. Supportive diagnostic tests:*Pulmonary funcion testsSpirometery Peak flow meterMethacholine challenge test*Allergic test *Chest x-ray *GERD assesment test

13. APPROACHES TO TREATMENT:1.Prevention of AG:AB reactions2.Neutralisation of IgE antibodyeg: Omalizumab3.Suppresssion of inflamation and bronchial hyperreactivityeg: cotricosteriods4.Prevention of realease of mediatorseg: mast cell stabilisers5.Antagonism of realeased mediatorseg: leukotrieneantagonists6.Blocked of constictor neurotransmitterseg:anticholinergics7.Mimicking dilator neurotransmittereg:sympathomimetics.8.Directly acting bronchodilatorseg:methylxanthines

14. CLASSIFICATION:Bronchodilatorsß2 sympathomimetics : Salbutamol, Terbutaline,SalmetrolMethylxanthines : Theophylline, AminophyllineAnticholinergics : Ipratropium bromideLeukotriene antagonists : Montelukast, ZafirlukastAnti-inflammatory agentsMast cell stabilisers : sodium cromoglycate, NedocromilCorticosteriodsInhalational : Beclomethasone, fluticasone Systemic : Hydrocortisone, PrednisoloneAnti-IgE antibody : Omlizumab

15. STEPWISE MANAGEMENT OF ASTHMA:Mild intermittent asthma ↓ Regular preventer therapy ↓ Add -on therapy ↓ Persistent poor control ↓ Continuous or frequent use of oral steriod

16. SHORT -ACTING ß2 AGONISTS:Eg: Salbutamol, T erbutalineThese are mainstay of asthma managementM.O.A:ß2 Receptor stimulation ->↑edcAMP in bronchial muscle cell -> relaxationRoute of administration:By inhalation of aerosol, powder.Salbutamol is given as intravenous infusion in status asthmaticus.Adverse reactions:Down regulation of bronchial ß2 receptors Tachycardia , palpitations

17. CORTICOSTEROIDS:Corticosteriods afford more complete and sustained symptomatic relief than bronchodialators and othersM.O.A: Decrease formation of cytokines(Th2), that recruit and activate eosinophils and are responsible for promoting the production of IgE and expression of IgE receptors.INHALED CORTICOSTERIODS:Eg: Beclomethasone, fluticasone, ciclesonide1ST choice in patients with any degree of persistent asthma

18. ROUTE OF ADMINISTRATION:Inhalation by MDI SLOWLY and DEEPLY inhalation for solution type inhalers QUICKLY and DEEPLY inhalation for dry powdet inhalersADVERSE REACTIONS:Hoarseness Oral or pharyngeal candidiasis Adrenal suppressionICS directly targets underlying airway inflammation

19. .SYSTEMIC STERIODSEG: Hydrocortisone, prednisolone These are oral steriodsUsed in status asthmaticus. ADVERSE REACTIONS:Adrenal suppression Cushing syndrome Growth suppression in children

20. ANTI-IgE ANTIBODY:Eg: OmalizumabM.O.A:This drug leads to ↓ed binding of IgE to high affinity IgE receptors on surface of mast cells and basophils and limits realease of mediators of allergic responseUSES: ◦In moderate to severe asthma patients who are poorly controlled with conventional therapy. ◦Reduces steriod requirements

21. Status Asthmaticus:In which the smooth muscles of the bronchi suddenly contract and narrow the airways.

22. Status asthmaticus can vary from a mild form to a severe form with bronchospasm.

23. Status asthmaticus is an acute episode of asthma that remains unresponsive to standard treatment with bronchodilators. symptoms: extreme difficulty with breathing, which causes restlessness

24. coughing and wheezing are not common, because there is not enough airflow

25. advanced symptoms include little or no breath sounds

26. inability to speak skin becomes bluish

27. heavy sweating

28. unconsciousness and even cardiopulmonary arrest, which can be fatalTREATMENT:Hospitalisation is necessary

29. The initial treatment starts with supplemental oxygen to increase blood oxygen levels.

30. Inhaled or intravenous bronchodilator to open the airways.

31. large doses of corticosteroids drugs and bronchodilators to reduce inflammation.

33. Conclusion:Asthma is a curable disease, so it is needed to take proper medication and there is a need to follow the medication therapy systematically.