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Asthma Overview
- 2. RESPIRATORY DISEASES OBSTRUCTIVE (ABCT) • Asthma • Brochiectasis • COPD/Cystic Fibrosis • Tracheal Obstruction RESTRICTIVE (AINT) • Alveolar (Edema, Bood and Pus) • Inflammatory, Idiopathic, Interstitial Lung Disease • Neuromuscular Diseases • Thoracic Wall deformities
- 3. DEFINITION • An abnormal bronchoconstriction of the airways. • It is REVERSIBLE obstructive pulmonary disease.
- 4. CAUSES
- 5. PRESENTATION WHEEZING SHORTNESS OF BREATH CHEST TIGHTNESS COUGH ↑ BREATHING RATE ↑ HEART RATE
- 6. PRESENTATION ACCESSORY MUSCLE USE ↓BREATH SOUNDS ↓ OXYGEN SATURATION ACCESSORY MUSCLE USE
- 7. INITIAL DIAGNOSTIC TESTS PEAK EXPIRATORY FLOW ARTERIAL BLOOD GAS (ABG) CHEST X-RAY
- 10. ABG
- 11. ABG NORMAL VALUES • pH 7.35-7.45 • PaO2 >80mmHg • PaCO2 35-45mmHg ACUTE ASTHMA • pH ↑ • PaO2 ↓ • PaCO2 ↓
- 13. ACCURATE DIAGNOSTIC TEST PULMONARY FUNCTION TESTING
- 15. PULMONARY FUNCTION TESTING (PFTs) • ↓ FEV1/FVC • ↑ RV • ↑ TLC • RV (Residual Volume) The volume of air remaining in the lungs. • TLC (Total Lung Capacity) The volume of air in the lungs at maximal inhalation, the sum of VC (Vital Capacity) and RV. VC (Vital Capacity) • The volume of air breathed out after the deepest inhalation.
- 16. PULMONARY FUNCTION TESTING • ↓ FEV1/FVC • ↑ RV • ↑ TLC PFTs are normal in between exacerbations. • FEV1 (Forced Expiratory Volume in 1 sec) Volume that has been exhaled at the end of the 1st second of forced expiration. • FVC (Forced Vital Capacity) The determination of the vital capacity from a maximally forced expiratory effort
- 17. OTHER DIAGNOSTIC TESTS ↑ Eosinophils (Normal = 1 - 3% Relative Value) . Complete Blood Count Skin Testing Serum IgE Levels METHACHOLINE TESTING • Methacholine is an artificial acetylcholine. Used when PFTs are normal but asthma is still suspected.
- 18. MEDICATIONS SABA (Short-Acting β- Agonists) ICS (Inhaled Corticosteroids) LABA (Long-Acting β- Agonists) SABA e.g. Albuterol Common Side-Effect: Oral Thrush ICS e.g. Beclomethasone LABA e.g. Salmeterol
- 19. ASTHMA - TYPES INTERMITTENT (TREATMENT) SABA PERSISTANT (TREATMENT) MILD SABA + ICS MODERATE SABA + ICS + LABA SEVERE SABA + ICS + LABA (AND POSSIBLE ORAL STEROIDS)
- 20. OTHER MEDICATIONS Theophylline Effective only for Prophylaxis of Asthma Cromolyn Montelukast, Zafirlukast
- 21. OTHER MEDICATIONS When SABA+ICS+LABA has all failed. E.g. Prednisolone Corticosteroids (Oral) Magnesium
- 22. OTHER MEDICATIONS Given to those with ↑IgE levels. Omalizumab E.g. Ipratropium Anti-Cholinergics
- 23. SALBUTAMOL Salbutamol metered dose inhaler is commonly used to treat asthma attacks.
- 24. SALBUTAMOL • The Spacer makes it easier to use the inhaler and helps ensure that more of the medication gets into the lungs instead of just into the mouth or the air. • With proper use, a spacer can make an inhaler somewhat more effective in delivering medicine.
- 25. FLUTICASONE • Steroid inhalers (Used for long-term control) - having a good inhaler technique and using a spacer device may reduce the risk of oral thrush. • Also, wash your mouth every time after using the inhaler to help remove any medicine particles left in your mouth.
- 26. ORAL THRUSH Oral Thrush: Common side-effect of chronic ICS (Inhaled Corticosteroids) use.
- 27. A-S-T-H-M-A A – Agonists (β2) S – Steroids T – Theophylline H – Humidified Oxygen M – Magnesium A – Anti-Cholinergics
- 28. MECHANICAL VENTILATION PaCO2: >50mmHg PaO2: <50mmHg
- 29. PREVENTION AVOIDANCE OF ALLERGENCE SMOKING BANS INFLUENZA AND PNEUMOCOCCAL VACCINATIONS