This document provides an overview of asthma, including: 1) Asthma is a chronic inflammatory disease of the airways characterized by recurrent wheezing, chest tightness, coughing, and shortness of breath. 2) Risk factors include genetic and environmental factors such as exposure to allergens, tobacco smoke, and viral infections. 3) Diagnosis is based on a patient's respiratory symptoms and improvement following bronchodilator treatment; spirometry can also be used.

1. Asthma
By :
Bushra Abdulrahman
Mzhda Salman
Shno Sabah
Parez Younis
Supervisor :
Dr. Kawez Zangana

2. Objectives
• What is Asthma
• Epidemiology
• Risk Factor
• Diagnosis
• Acute Severe Asthma
• Long term asthma management
• Advice and preventive measures
• prognosis

3. What is Asthma
• Asthma is a chronic inflammatory disease of the airways.
Recurrent
Reactive
Reversible

4. Asthma
shortness of
breath
Coughing
90 %
chest tightness
wheezing
74 %

5. Pathophysiology
Exposure to allergens &
irritants
IGE stimulation & Mast cells
degradation
Bronchospasm,mucus secretion & edema of the wall
Prostaglandins [Lukotrienes
Histamine

7. Epidemiology
. 30% of children wheeze by age 3 yrs
. only one third of these children have persistent symptoms up to age.
. M to F ratio is 1.8:1 in childhood
. At puberty ratio is equal

8. When Does Asthma Begin
.By 1 year - 26%
.1 -5 year - 51%
.> 5 year - 22 %
77% of asthma begins
in children less than 5 years.
It’s recurrent, there is complete cure between episodes.
But usually confirming the Diagnosis is after 5 years of age.

9. Risk factor
1) Genetic factors
2) Environmental factors ; mostly viral ,Exposure to tobacco smoke. Animals
, chemicals ,dusts, gases.
3) Atopic diseases ; eczema , allergic rhinitis.
4) Maternal status ; both physical and mental like anaemia & depression are
associated with asthmatic stress for the child.
5) Early antibiotic use ; 50% more likely to develop asthma .

11. a characteristic pattern of episodic respiratory symptoms and
signs in the absence of an alternative explanation
Diagnosis of Asthma is Purely
Clinical
Diagnosis

12. Respiratory
symptoms
predominant nonproductive
cough
Wheeze
Difficulty of Breathing or
Shortness of breath after exercise
Chest Pain

13. Personal History of Atopic disorder
Family History of Asthma or Atopic Disorder
History of Improvement of symptoms
or lung function after using bronchodilators

14. Classification of Asthma
Mild Symptoms > 2 times
a week but < 1 time a
day
Night Symptoms > 2 times a month
Moderate PEFR 50-80%
Predicted ,persistent
cough, loud wheeze
With Daily use of inhaled short-acting 2-
agonist Exacerbations ≥ 2 times a week; may
last days
Acute Severe PEF< 30-50% predicted , Inability to complete sentence in 1 breath,
Signs of Respiratory Distress . ↑RR , ↑ HR . Normal PaCo2
Life Threatening PEF< 33% predicted , SpO2 < 92% or PaO2 < 8kPa (60mmHg) . Silent
chest, ↓ HR , ↓ BP , Confusion , Coma ,
Near Fatal High PaCo2 or requires Mechanical ventilation

15. Severe Asthma Attack
Respiratory distress

16. Chest Exam
Inspection : Barrel-shaped chest, decreased movement and Intercostal retractions
Palpation : Increased tactile fremits
Percussion: Hyper resonance chest.
Auscultation : Decreased air entry, Wheeze and prolonged expiration, decreased
vocal resonance

17. Investigations
Spirometry
Spirometer ,Procedure , Limitations of test age > 6 year
CXR
We will do PA or Lateral View, it will show hyper inflated chest
Pulse oximetry
for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation

18. Parameters of Spirometry
• Peak expiratory flow rate (PEFR) <80% predicted for height.
• FEV1/FVC <80% predicted.
• Concave scooped shape in flow volume curve.
• Bronchodilator response to β-agonist therapy (i.e. 15% increase in FEV1 or
PEFR).

22. Acute exacerbation of
Asthma

23. Management of asthma exacerbations:
• Initial assessment:
• Supportive treatment: Supplemental O2(humidified), IV Fluid, Antibiotics..
• Nebulized SABA: e.g. salbutamol (ventolin).
• Oral systematic or IV Corticosteroids.
• Anti cholinergic: Ipratropium bromide.
• IV MgSO4.
• epinephrine IM or turbutaline Sc.
• Intubation & Mechanical ventilation with 100% oxygen.

24. Complications of acute severe asthma:
Aspiration pneumonia
Pneumothorax
Massive lung collapse
Pneumomediastinum and surgical emphysema
Acute Respiratory failure and Respiratory arrest
Cardiac arrest

25. Long term asthma management
The long-term goals of asthma management :
• to achieve good symptom control
• to minimize future risk of exacerbations
• fixed airflow limitation and side-effects of treatment.

26. The control-based asthma management cycle

27. ASTHMA MEDICATIONS
Controller medications
Reliever (rescue) medications
Add-on therapies for patients with severe asthma

28. Classify a Child as Chronic Asthma
• Infrequent episodic asthma (<4 episode per yr) (SABA)
• Frequent episodic (every 2-4wk) (relieve by SABA with use regular low ICS)
• Persistent asthma(> or = 3 episodes with cough at night/early
morning) (ICS,LABA,Oral steroid, leukotriene inhibitors)
• Exercise induced asthma (use SABA before exercise)(if severe ICS)

32. Advice and preventive measure
• Self-monitoring of symptoms
and/or peak flow
• Physical activity
• Avoidance of occupational
exposures
• Avoidance of medications that
may make asthma worse
• Healthy diet
• Avoidance of indoor allergens
• Weight reduction
• Allergen immunotherapy
• Breathing exercises
• Avoidance of indoor air
pollution
• Vaccinations
• Bronchial thermoplasty
• Avoidance of outdoor allergens

33. Prognosis
• Occur in 35% of pre-school children 1/3 continue to have persistent asthma , 2/3 will improve
• Children with mild + normal lung function are likely to improve over time
• Children with moderate to severe asthma +lower lung function measures are likely to have
persistent asthma
• Complete remission uncommonly occur