asthma disease pathophysiology and treatment case presentation chronic asthma

1. Asthma
1

2. • Asthma is a chronic inflammatory obstructive lung
disease characterized by:
• Airway obstruction that is reversible either spontaneously or with
treatment
• Airway inflammation.
• Increased airway responsiveness to a variety of stimuli.
“physical, chemical, immunological, …etc.”
Asthma 2

3. Asthma 3

4. Asthma has two phases:
- Early Phase - Late phase
Early phase:
• Immediate and spontaneous bronchoconstriction
after inhaling a specific allergen.
• This phase improves over an hour, reversed easily
by inhalation of bronchodilators.
Asthma 4

5. Late phase:
• Occurs 4-12 hours later.
• More severe and prolonged, difficult to reverse
with bronchodilators.
• Inflammation is a key factor here.
Asthma 5

6. Asthma 6

7. • Symptoms:
• dyspnea, cough(especially at night), wheezing, and
chest tightness, whistling sound when breathing
• Symptoms may occur more often at night, early in the
morning, or with exercise.
Asthma 7

8. • Symptoms : severe dyspnea, shortness of breath, chest
tightness, or burning.
• The patient is only able to say a few words with each
breath.
• Symptoms are unresponsive to usual measures (short-
acting inhaled B2-agonist administration).
Asthma 8

9. • Asthma could be mild, moderate or severe
according to the frequency of symptoms.
Asthma 9

10. Asthma 10

11. Asthma 11

12. 1. Prevent troublesome symptoms( cough.
Breathlessness)
2. Maintain normal or near normal pulmonary function.
3. Infrequent use <= 2 days/week of short acting B2
agonist(not include Exercise induced)
4. Maintain normal daily activity levels.
5. Prevent recurrent exacerbations of asthma.
6. Prevent loss of lung function
7. Minimal or no adverse effects of therapy
Asthma 12

13. 1. Correction of hypoxemia
2. Rapid reversal of airways obstruction (within min )
3. Reduction of the likelihood of recurrence of severe
airflow obstruction
Asthma 13

14. • Patient’s education towards
• Their disease
• Their medication
• How to recognize early signs of deterioration
• How to recognize triggers for asthmatic attacks.
• identify the exacerbating factor & try to avoid it.
• Smoking
• Pets
• house mist
• Dust
• all can exacerbate the case.
Asthma 14

15. Asthma 15

16. Asthma 16

17. Asthma 17

18. • Evaluation of asthma exacerbation severity in the
urgent or emergency care setting:

20. Asthma 20

21. • A 5 year-old female patient, previously healthy,
presented to clinic complaining of cough, associated
with rapid breathing and audible breath sounds, no
cyanosis, no apnea.
T 37, RR 60 , P 100
• at the same time of the last year she developed the
same attack.
Asthma 21

22. PATIENT INFORMATION
• R.A.N
• Admission date 28|4|2014
• File ID: KA0025800
• Height 114 cm
• Weight 20 Kg.
• BMI 15.38 “normal”
• Vaccination: up to age
• No known allergies.
Asthma 22

23. FH
• Parents: Father has atopic conjunctivitis
previously diagnosed with allergic rhinitis
Mother medically free.
• Has 2 male brothers. “one of them has eczema”
Asthma 23

24. PMH
• Last year, she developed same symptoms, and admitted
to the hospital.
Discharged on two inhalers “as needed” and “regular” as
the mother mentioned.
• The physician told her to use it for two months.
• She improved and had no other symptoms until this
admission.
• 3 years ago developed same symptoms, same time.
Asthma 24

25. Asthma 25
Lab Result Normal Range
WBC 11.6 x10^3uL 5-14.5
RBC 4.67 miluL 4.5-10
Hgb 13.2 gdL 11.5-14.5
HCT 37.3 % 37-47
MCV 79 micm^3 80-95
PLT 320 x10^3uL 250-550
Lymph 7.3 20-45
Mono 4.7 2-6
Neutro 50 60-75
Eosin 10.2 1-3
Na+ 137 mEq/L 136-145
K+ 3.94 mEq/L 3.5-5
Urea 2.9 mol/L 2-8.3
Cr 0.79 mg/dL 05-1.5

26. Asthma 26
Lab Result Normal Range
pH 7.452 7.32-7.42
pCO2 25.2 38-52
HCO3 17.2 19-25
BE 4 -5 - +5
pO2 40.5 24-48

27. Medication
Asthma 27
Medication Dose Frequency Route
Salbutamol 0.5 ml Q2h Nebulizer
Budesonide 250 ml Q12h Nebulizer
Methylprednisone 10 mg Q6h IV
Ranitidine 30 mg Q24h IV
1/5 G/S 63 ml Q1h IV infusion
Salbutamol 1 ml STAT Nebulizer
Salbutamol 1 ml STAT Nebulizer

28. COMMENTS
• The patient is improving.
• Cont. cortisone therapy for 5 days.
• Consider discharge patient on albuterol MDI, and
budesonide inhaler.
• d/c Ranitidne
• Encourage eating well, to d/c IVF.
Asthma 28

29. • Monitor side effect of the drugs use.
• O2 sat and blood gases, KFT, Glu.
• Monitor how many times respiratory distress
• Adherence to the medication.
• The right use of the drug.
MONITORING

30. Asthma 30

31. • Many patients under use long-term preventive therapy
because no health professional took the time to
adequately instruct them that asthma is preventable.
While under-using the most important medicines for long-
term control, many patient overuse “quick relievers”
• Difficulty using dose inhaler, teaching patients the correct
use of MDIs and MDIs plus spacers is absolutely
essential. In one study, 89% of patient could not perform
all steps correctly.
Asthma 31

32. PATIENT EDUCATION
• MDI
• Shake well
• Prepare your breath
• Put between lips and
seal well
• Inhale slow and deep
• Hold for ~10 sec
• Rinse your mouth and
spit water to avoid
dental caries.
• DPI
• Don’t’ shake
• Prepare your breath
• Put between lips and
seal well
• Inhale fast and deep
• Hold for ~10 sec
• Rinse your mouth and
spit water to avoid
fungal infection
Asthma 32

33. Asthma 33
THANK YOU
AHMAD NOURI