Asthma is a chronic lung disease characterized by inflammation of the airways, wheezing, shortness of breath, and coughing. It is caused by environmental triggers like dust, pollen, or viruses. Symptoms include coughing, wheezing, chest tightness, and shortness of breath. Asthma is diagnosed based on a patient's medical history and symptoms, and tests like spirometry. While there is no cure, treatment focuses on reducing inflammation and controlling symptoms using long-term control medications like inhaled corticosteroids and quick-relief medications for acute symptoms. The goal of treatment is to help patients live normal, active lives with minimal asthma symptoms or flare-ups.

1. ASTHMA
By Aneela Kanwal
ASTHMA
By
Andleeb Sultana

2. DERIVATION OF ASTHMA
The word Asthma is derived from the Greek word
azein(to breath hard)

3. DEFINATION
Asthma is a common chronic inflammatory disease of
the airways characterized by variable and recurring
symptoms, reversible airflow obstruction and
bronchospasms

6. Symptoms
SYMPTOMS
Coughing
wheezing
shortness of breath
tightness in the chest.

7. HISTORY
Asthma had existed in Egyptian times ,or may be be
Old ancient asthma cure was to heat a mixture of herb
bricks and to breath in the fumes.
It also became common in China, a few hundred years
ago.
To cure Asthma in China they would have a herb
containing ephedrine which they would inhale
Ephedrine
It is used for temporary relief o
shortness of breath , chest tightn
and wheezing due to bronchial

8. EPIDIMOLOGY
As of 2011, 235–330 million people worldwide are affected by
asthma
 Approximately 250,000-345,000 people die per year from the
disease.
Around 7.5 million Pakistani adults and 15 million children
suffer from asthma due to the increasing urban population,
enlarging intercity industries, air pollution and other
environmental factors. In pakistan due to asthma deteath rate
is 5.1%.

9. CAUSES
•Animals (pet hair or dander)
•Dust mites
•Certain medicines (aspirin and other NSAIDS)
•Changes in weather (most often cold weather)
•Chemicals in the air or in food
•Exercise
•Mold
•Pollen
•Respiratory infections, such as the common
cold
•Strong emotions (stress)
•Tobacco smoke

10. TYPES OF ASTHMA
Child-Onset Asthma
Adult-Onset Asthma
Cough-Induced Asthma
Exercise-Induced Asthma
Occupational Asthma
Nocturnal Asthma
Steroid-Resistant Asthma

11. Child-Onset Asthma
Asthma that begins during childhood is called child-onset asthma. This type of
asthma happens because a child becomes sensitized to common allergens in the
environment - most likely due to genetic reasons. The child is atopic - a genetically
determined state of hypersensitivity to environmental allergens.
Adult-Onset Asthma
This term is used when a person develops asthma after reaching 20 years of age. Adult-
onset asthma affects women more than men, and it is also much less common than
child-onset asthma.

12. Exercise-Induced Asthma
If you cough, wheeze or feel out of breath during or after exercise, you could be
suffering from exercise-induced asthma. Obviously, your level of fitness is also a
factor - a person who is unfit and runs fast for ten minutes is going to be out of breath.
However, if your coughing, wheezing or panting does not make sense, this could be
an indication of exercise-induced asthma.
Cough-Induced Asthma
Cough-induced asthma is one of the most difficult asthmas to diagnose. The doctor
has to eliminate other possibilities, such as chronic bronchitis, post nasal drip due
to hay fever, or sinus disease. In this case the coughing can occur alone, without
other asthma-type symptoms being present. The coughing can happen at any time
of day or night. If it happens at night it can disrupt sleep.

13. Occupational Asthma
This type of asthma is triggered by something in the patient's place of work.
Factors such as chemicals, vapors, gases, smoke, dust, fumes, or other particles
can trigger asthma. It can also be caused by a virus (flu), molds, animal products,
pollen, humidity and temperature. Another trigger may be stress.
Nocturnal Asthma
Nocturnal asthma occurs between midnight and 8 AM. It is triggered by allergens in
the home such as dust and pet dander or is caused by sinus conditions. Nocturnal or
nighttime asthma may occur without any daytime symptoms recognized by the
patient. The patient may have wheezing or short breath when lying down and may not
notice these symptoms until awoken by them in the middle of the night - usually
between 2 and 4 AM.

14. Steroid-Resistant Asthma
Asthma is usually a steroid responsive disease. A few patients respond
poorly to these drugs, and others need such high doses to control the
disease that side-effects become a serious problem. The term steroid
resistant asthma is used for both groups. In some patients, factors may
be operating to make the asthma worse and, thus, to increase the
requirement for steroids

15. ASTHMA CLASSIFICATION
Asthma classification Signs and symptoms
Mild intermittent
Mild symptoms up to two
days a week and up to two
nights a month
Mild persistent
Symptoms more than twice
a week, but no more than
once in a single day
Moderate persistent
Symptoms once a day and
more than one night a
week
Severe persistent
Symptoms throughout the
day on most days and
frequently at night

16. DIAGNOSIS
Medical and Family Histories
Physical Exam
Test

17. DIAGNOSIS TEST
Spirometry
Peak flow

19. OTHER TEST
Methacholine challenge
Imaging tests.
Nitric oxide test

20. Asthma is Incurable
Asthma is an incurable illness. However, with good treatment
and management there is no reason why a person with
asthma cannot live a normal and active life.

21. TREATMENT
Goals Of Treatment:
Control airway swelling
Stay away from substances that trigger your
symptoms
Help you to be able to do normal activities
without asthma symptoms

22. MEDICATIONS
There are two main groups of asthma medication
Long-Term Control Medicines
Quick-Relief Medicines

23. LONG TERM CONROLL MEDICINE
This medications make the airways less sensitive, reduce redness
and swelling and help to dry up mucuse.
oInhaled corticosteroids
oLeukotriene modifiers
oLong-actingbeta2-agonists
oTheophylline

24. Inhaled corticosteroids
Purpose: Control
Drug names:
Beclomethasone (Qvar®)
Budesonide (Pulmicort)
Inhaled corticosteroids are the most effective medications to reduce airway
inflammation and mucus production. The use of these medicines leads to better
asthma control with fewer symptoms and flare-ups and less of a need for
hospitalization

26. Long-acting forms beta2-agonists
Purpose:
Control
Drug names:
Salmeterol (Serevent®)
Formoterol (Foradil®)
The long-acting forms of beta2-agonists are used for better control, not
for relief. These drugs take longer to work and the benefits last longer,
even up to 12 hours. Salmeterol (Serevent®) and formoterol (Foradil®)
are the only inhaled, long-acting beta2-agonists. They are used twice a
day to maintain the open airways for long-term control. This is especially
helpful overnight

27. Leukotriene modifiers
Purpose: Control
Drug names:
Zafirlukast (Accolate®)
Zileuton (Zyflo®)
Montelukast (Singulair®)
Forms: Leukotrienes are chemicals that occur naturally in our bodies and cause
tightening of airway muscles and production of mucus. Leukotriene modifier
medications work by blocking the actions of leukotrienes in the body. Studies are
showing that these medications are helpful in improving airflow and reducing
asthma symptoms.

28. Theophylline
Purpose:
Control
This medication is available only in the oral form. It is long-acting and prevents
asthma episodes. It is used in difficult-to-control or severe asthma. It must be
taken daily and doses cannot be missed

29. Quick-Relief Medicines
Relievers are fast acting medications that give quick relief of
asthma symptoms (wheeze, cough, shortness of breath).
Anticholinergics
Short-acting forms beta2-agonists

30. Anticholinergic drugs
Purpose:
Relief
There are two anticholinergic bronchodilators currently available—Ipratropium bromide
(Atrovent® HFA), which is available as a metered dose inhaler and nebulizer solution, and
tiotropium bromide (Spiriva®), which is a dry powder inhaler. Ipratropium is used 4 times
per day whereas tiotropium is used only once per day as its action lasts for 24 hours.
These are not quick relief medications but medications that can enhance the
bronchodilator effect for certain asthmatics with difficult-to-control symptoms

31. Short-acting forms beta2-agonists
Purpose:
Relief
Short-acting beta2-agonists are rescue medications that relieve symptoms very
quickly. They work within 20 minutes and last for 4 to 6 hours. They are the
medications to use 15 to 20 minutes before exercise to prevent exercise-induced
symptoms. The inhaled forms are the best for treating sudden and severe or new
asthma symptoms.
Drug names:
Albuterol (Ventolin)
Metaproterenol (Alupent®)

32. combination medications
There are some inhalers that contain a combination of two different medications. These
inhalers allow both medications to be delivered from one device, shortening treatment
times and decreasing the number of inhalers
Advair
A combination of fluticasone and salmeterol
Symbicort
A combination of budesonide and formoterol

33. Xolair
Xolair is an injectable biologic medication approved for treatment of chronic
allergic asthma .Xolair is an anti-IgE medication that binds to and blocks the
attachment of immunoglobulin E (IgE) to its receptor on the surface of immune
cells called mast cells and basophiles. Antibodies are proteins that protect the
body from foreign substances and they are major components of the immune
system. IgE is a type of antibody that binds to specific receptors in response to
foreign proteins such as bacteria and allergens. IgE activates immune cells
causing the release of histamine, a chemical which is responsible for symptoms of
asthma .Blocking the action of IgE means less histamine is released, reducing
symptoms of asthma and hives.

34. Bronchial Thermoplasty
In bronchial thermoplasty, a long, flexible tube called a bronchoscope is
passed through the nose or mouth and down into the lungs until it reaches
the airways. A special fine wire is then passed down through the
bronchoscope until the end touches the airways. Radio waves are then
used to heat up the wires touching the airways. This heats up the airway
lining in a very controlled manner to about 65 degrees Celsius and this heat
causes some of the muscle surrounding the airways to break up. This then
makes it more difficult for the muscles surrounding the airways to tighten.
The aim is to reduce asthma symptoms and the risk of asthma attacks.

35. A nebuliser is a machine that creates a mist of medicine, which is then breathed in
through a mask or mouthpiece. They are more commonly used to give high doses
of reliever medicine in an emergency situation,
Nebuliser
Spacers
A spacer is a large plastic or metal container, with a mouthpiece at one end and a
hole for the aerosol inhaler at the other.
Spacers are important because they help to deliver asthma medicine to your lungs.
They also make your inhaler easier to use and reduce the risk of side effects.
Inhalers
Asthma inhalers are the most common and effective way to deliver asthma
drugs to the lungs. They are available in different types that require different
techniques for use. Some inhalers deliver one medication and others contain
two different medications

37. SIDE EFFECTS OF CORTICOSTEROIDS
Common symptoms include:
sore throat
hoarse voice and/or
oral thrush
skin bruising
cataracts
glaucoma
adrenal suppression
growth suppression and/or
osteoporosis

38. SIDE EFFECTS OF LEUKOTRINE
MODIFIERS
Side effects are uncommon, but may
include
Muscle or joint pain,
Gastrointestinal disturbances,
Headache
Mood changes.

39. Side Effects of Short-acting beta-agonists
Possible side effects include:
Increased heart rate
Muscle tremor (shaking, especially in the hands)
Slight feelings of anxiety or nervousness

40. Side effects of Anticholinergics
Possible side effects include:
Dry mouth
Throat irritation
Agitation if taken in excessive doses
Glaucoma

41. PREVENTION
Learn about your asthma and ways to control it.
Follow your written asthma action plan.
Use medicines as your doctor prescribes.
Identify and try to avoid things that make your asthma
worse (asthma triggers). However, one trigger you
should not avoid is physical activity. Physical activity is
an important part of a healthy lifestyle. Talk with your
doctor about medicines that can help you stay active.
Keep track of your asthma symptoms and level of
control.
Get regular checkups for your asthma.

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for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung,
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REFERENCE