Download to read offline
Uploaded byGabi Cismaru
Asthma oct 2021 romani pptx
This document summarizes information about two asthma case studies. For case one, it describes a 66-year-old man who stopped his blood pressure medication and presented with coughing, dyspnea, wheezing and crackles. Tests showed elevated BNP and arterial blood gases indicative of mild to moderate asthma. For case two, it describes a 16-year-old girl with a history of asthma who presented with shortness of breath, wheezing and tachycardia. Laboratory tests showed elevated eosinophils. Both cases were diagnosed with acute exacerbation of asthma. The document then provides further details on the definition, causes, symptoms, examinations, tests and treatment of asthma.
More Related Content
Similar to Asthma oct 2021 romani pptx
![Asthma [Respiratory] by ninja nerd [Notes].pdf](https://cdn.slidesharecdn.com/ss_thumbnails/1asthmanotes-251015215849-38a7ee6a-thumbnail.jpg?width=640&height=640&fit=bounds)
![PERI-PROSTHETIC FRACTURE NAIL-PLATE CONSTRUCT [NPC].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/drarunkumardrmohamedashrafperiprostheticfrasturenail-plateconstructnpc-260209164459-7e9d15a1-thumbnail.jpg?width=640&height=640&fit=bounds)
Asthma oct 2021 romani pptx
- 1.
- 2. CASE No 1 age:66 • Dan B. Pascaru • HTA from age 45 – Amlodipine – Perindopril
- 3. Case No 1 •Stopped medication in sept 2018
- 4. CASE No 1 •Symptoms (2 days) – Coughing – Dyspneea • Signs: – Wheezing – Crackles
- 5. CASE No 1 •Symptoms (2 days) – Coughing – Dyspneea • Signs: –Wheezing – Crackles
- 6. DIAGNOSIS • ACUTE EXACERBATIONOF ASTHMA ?
- 7. Laboratory Tests ? FIRSTLINE SECOND LINE
- 8. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 9. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP = 12.000 SECOND LINE • Sputum examination
- 10. Beta2 mimetics !prof • Tachycardia • Arrhytmias • Myocardial ischemia
- 11. Case No 2 age:16 Melinda Pasca • History of asthma • 2 crisis at age of 14 • 2 crisis/year • No medication
- 12. Case No 2 Symptoms(2 hours) • tachypnea • acute shortness of breath • audible wheezing “I feel like a fish out of water” Signs: Wheezing HR 110, RR 40
- 13. DIAGNOSIS • ACUTE EXACERBATIONOF ASTHMA ?
- 14. Laboratory Tests ? FIRSTLINE SECOND LINE
- 15. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 16. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 17. Complete blood count •Hb=12,7 • WBC=7000 • Pl=230.000 • Eosinophil count=15% N=(1-4%) • ESR=14 mm (N=0-9mm) • CRP=N • Fbg=N
- 18. Paraclinical Tests FIRST LINE •EKG • Chest radiograph • Echocardiography SECOND LINE • Spirometry
- 19. Paraclinical Tests FIRST LINE •EKG • Chest radiograph • Echocardiography SECOND LINE • Spirometry
- 21. Laboratory Tests FIRST LINE •EKG • Chest radiograph • Echocardiography SECOND LINE • Spirometry
- 23. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 24. Arterial Blood Gases? pH PaCO2 HCO3 - PaO2 (Slightly) pH= 7.5, PaCO2= 27, HCO3- =22 PaO2= 75
- 25. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP=120 SECOND LINE • Sputum examination
- 26. DIAGNOSIS: ASTHMA • Mild? • Moderate ? • Severe ?
- 30.
- 31. DEFINITION Chronic or acutedisease ?
- 32. DEFINITION • Common chronicdisorder of the airways • Characterized by – Variable and recurring symptoms – Airflow obstruction – Bronchial hyperresponsiveness – And underlying inflamation
- 33. In a classof 30 students, you can expect 2 to 3 students WILL have asthma
- 34. Etiology • Extrinsic asthma –Allergic or atopic asthma • Intrinsic asthma – Nonallergic or nonatopic asthma
- 35. Anatomic Alterations ofthe Lungs • Smooth muscle constriction of bronchial airways (bronchospasm) • Excessive production of thick, whitish, tenacious bronchial secretions • Hyperinflation of alveoli (air-trapping) • Mucus plugging and, in severe cases, atelectasis
- 36. Figure 13-2. Theimmunologic mechanisms in asthma.
- 37. Intrinsic Asthma (Nonallergic orNonatopic Asthma) • Infections • Exercise and cold air • Industrial pollutants or occupational exposure • Drugs, food additives, and food preservatives • Gastroesophageal reflux • Sleep (nocturnal asthma) • Emotional stress • Premenstrual asthma
- 38.
- 39. Vital signs • Increasedrespiratory rate • Increased heart rate, cardiac output, blood pressure Clinical Data
- 40. Figure 2-12. Percussionbecomes more hyperresonant with alveolar hyperinflation.
- 41. Figure 2-17. Asair trapping and alveolar hyperinflation develop in obstructive lung diseases, breath sounds progressively diminish.
- 42. Chest assessment findings •Expiratory prolongation 1:3, 1:4 • Decreased tactile and vocal fremitus • Hyperesonant percussion • Diminished breath sounds • Diminished heart sounds • Wheezing and rhonchi Clinical Data
- 43. • General findings •Use of accessory muscles of inspiration • Use of accessory muscles of expiration • Pursed-lip breathing • Substernal intercostal retractions • Increased anteroposterior chest diameter (barrel chest) • Cyanosis • Cough and sputum production • Pulsus paradoxus ? Clinical Data
- 44. Pulsus paradoxus • Decreasedblood pressure during inspiration • Increased blood pressure during expiration Clinical Data
- 45. Paradoxical pulse • =abnormally large decline in systolic arterial pressure during inspiration
- 46. NONPULMONARY MANIFESTATIONS • Signsof atopy or allergic rhinitis • Skin atopic dermatitis, eczema, or other manifestations of allergic skin conditions.
- 47.
- 48. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 49. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 50. COMPLETE BLOOD COUNT -Blood eosinophilia greater than 4% or 300-400/µL is consistent with the diagnosis of asthma, but - a normal value is not exclusionary.
- 51. - IgE >100IU patients with allergic reactions - test for allergic sensitivity : - allergy skin tests (Prick test) - blood radioallergosorbent tests (RAST).
- 52. Paraclinical Tests FIRST LINE •EKG • Chest radiograph • Echocardiography SECOND LINE • Pulmonary Function Study
- 53. Paraclinical Tests FIRST LINE •EKG • Chest radiograph • Echocardiography SECOND LINE • Pulmonary Function Study
- 54. Radiologic Findings Chest radiograph •Normal • Hyperinflation – Increased anteroposterior diameter – Translucent (dark) lung fields – Depressed or flattened diaphragm
- 56. Laboratory Tests FIRST LINE •Complete blood count • EKG • Chest radiograph • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 57. ABG • pH=7,35-7,45 • paCO2=35-45mmHg •SaO2=93-98% • paO2=80-100mmHg • HCO3=24-26mEq/l
- 59. Arterial Blood Gases Mildto Moderate Asthma Episode Acute alveolar hyperventilation with hypoxemia pH PaCO2 HCO3 - PaO2 (Slightly)
- 61. Arterial Blood Gases SevereAsthmatic Episode (Status Asthmaticus) Acute ventilatory failure with hypoxemia pH PaCO2 HCO3 - PaO2 (Significantly)
- 62. Laboratory Tests FIRST LINE •Complete blood count • EKG • Chest radiograph • Arterial Blood Gases • BNP SECOND LINE • Pulmonary Function Study • Sputum examination ratio
- 64.
- 65.
- 66.
- 67.
- 69. Laboratory Tests FIRST LINE •Complete blood count • Biochemistry • Coagulation • Arterial Blood Gases • BNP SECOND LINE • Sputum examination
- 70. Sputum examination • Eosinophils •Charcot-Leyden crystals (see next slide) • Casts of mucus from small airways –called Kirschman spirals • IgE level (elevated in extrinsic asthma)
- 71. Charcot-Leyden Crystals Needle shapedcrystals - Represents breakdown products of eosinophils
- 73. DIFFERENTIAL DIAGNOSIS ? •LEFT HEART FAILURE • COPD
- 74.
- 75.
- 76. • Pulmonary FunctionTesting -the degree of reversibility in FEV1 which indicates a diagnosis of asthma is generally accepted as ≥ 12% and ≥ 200 ml from the pre-bronchodilator value the administration of a short-acting bronchodilator. PARACLINICAL EXAMINATIONS
- 77. Figure 9-10. Bronchospasmclinical scenario (e.g., asthma). ASTHMA
- 78. Figure 9-11. Excessivebronchial secretions clinical scenario. COPD
- 83. GINA FEV 1 >80%
- 84. GINA FEV 1 >80% FEV 1 > 80%
- 85. GINA FEV 1 =60-80% FEV 1 > 80% FEV 1 > 80%
- 86. GINA FEV 1 =60-80% FEV 1<60% FEV 1 > 80% FEV 1 > 80%
- 87.
- 88. 1. Wich ofthe folowing are clinical findings in asthma ? a) Wheezing b) Retrosternal thoracic Pain c) Diminished breath sounds at auscultation d) Decreased heart rate (bradycardia) e) Hepatomegaly, jugular distension and edema
- 89. 2. In asthma,laboratory tests show: a) Elevated BNP > 12.000 b) Increased anteroposterior diameter in X-ray c) Elevated pH in mild to moderate asthma d) restrictive respiratory disfunction in spirometry e) Thrombus in right pulmonary artery
- 90. 3. What isthe treatment for acute asthmatic chrisis ? a) Symbicort 3-4 times a day b) Spiriva 1/day c) Salbutamol d) Oxygen e) Intravenous Amynophiline
- 91.
- 95. TREATMENT • 1 • 2 •3 • 4 • 5 • 6
- 96. cromones R 1 2 34 5 IgE antagonist
- 97.
- 98. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6 CLASIFICATION 3
- 99. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 100. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 101.
- 102. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 103. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 105. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 106. Beta2 agonists • Short-acting •FENOTEROL • SALBUTAMOL • TERBUTALINE • Long-acting • FORMOTEROL • SALMETEROL 1 4 hours 12 hours
- 107. Beta2 agonists • Short-acting •FENOTEROL =BEROTEC • SALBUTAMOL =VENTOLIN • TERBUTALINE =BRYCANIL • Long-acting • FORMOTEROL=OXIS TURBUHALER • SALMETEROL=SEREVENT 1 4 hours SELECTIVES 12 hours
- 109. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 110. Anticholinergics • Short-acting • IPRATROPIUM BROMIDE •OXITROPIUM BROMIDE • Long-acting • TIOTROPIUM 2
- 111. Anticholinergics • Short-acting • IPRATROPIUM BROMIDE=IPRAVENT •OXITROPIUM BROMIDE=ATROVENT • Long-acting • TIOTROPIUM =SPIRIVA 2 24 hours 6 hours
- 112. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 113. Methylxantines • Short-acting • Aminophyline •Long-acting • Theophyline (SR) 3
- 114. Methylxantines • Short-acting • Aminophyline =MIOFILIN •Long-acting • Theophyline (SR) 3
- 116. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 117. Glucocorticosteroids • Systemic • Prednisone •Methyl-prednisolone • Inhaled • Beclomethasone • Budesonide • Fluticasone 4 HHC in acute form Long action
- 118. Glucocorticosteroids • Systemic • Prednisone •Methyl-prednisolone • Inhaled • Beclomethasone=BECOTIDE • Budesonide=PULMICORT • Fluticasone=FLIXOTIDE 4 HHC in acute form Long action
- 120. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 121.
- 122. Phosphodiesterase-4inhibitors • Cromolyn =INTAL •Nedocromil=TILADE 5
- 123. bronchospasm anticholinergics methylxanthines beta2 simpaticomimetics Inflamation andedema glucocorticosteroids Mastocite degranulation Phosphodiesterase-4 inhibitors 1 2 3 4 5 Leukotriene inhibitors 6
- 124. Leukotriene -inhibitors • Montelukast •Zafirlukast • Zileuton 6
- 125. Leukotriene -inhibitors • Montelukast=SINGULAIR • Zafirlukast=ACCOLATE • Zileuton=ZYFLO 1/day 2/day 4/day 6
- 127. COMBINATIONS – inone inhaler • Short-acting β 2 agonist plus anticholinergic FENOTEROL+IPRATROPIUM SALBUTAMOL+IPRATROPIUM • Long-acting β 2 agonist plusglucocorticosteroids FORMOTEROL+BUDESONIDE SALMETEROL+FLUTICASONE
- 128. COMBINATIONS – inone inhaler • Short-acting β 2 agonist plus anticholinergic FENOTEROL+IPRATROPIUM= BERODUAL SALBUTAMOL+IPRATROPIUM= COMBIVENT • Long-acting β 2 agonist plusglucocorticosteroids FORMOTEROL+BUDESONIDE= SYMBICORT SALMETEROL+FLUTICASONE= SERETIDE 25/50 25/125 25/250
- 131. ASTHMATIC CRISYS TREATMENT •? • ? • ? • ? • ?
- 132. ASTHMATIC CRISIS TREATMENT •1)Beta2 mimetics (VENTOLIN) • 2)ATROVENT (IPRATROPIUM BROMIDE) • 3)AMYNOPHILINE (Miofilin 1-1-1 inj//day) • 4) HHC 100mg (1-0-1 inj/day) • 5)______ • 6)______
- 133. ASTHMATIC CRISIS TREATMENT •Oxygen • Antibiotics : Ampiciline, Cefalosporines, Quinolones • Mucolitics: water, Acetilcisteine 3/day, Bromhexine. • Bicarbonate • ADRENALINE 0,3-0,5 ml • Prednisone 30-40 mg/day < 5 mg/5 days • Mechanical ventilation
- 134. CHRONICAL TREATMENT • 1)Longacting beta 2 mimetics: Serevent • 2)___________COPD • 3)Teotard • 4) inhaled glucosteroids: Becotide, Pulmocort, Flixotide • 5) Cromolyn, Nedocromil • 6)Leukotriene inhibitors: Singulair, zafirlukast, Zileuton
- 135.
- 140. Beta2 mimetics ! •Tachycardia • Arrhytmias • Myocardial ischemia
- 141. OMALIZUMAB • Monoclonal antibody againstIgE • Expensive and requires monthly injections • Most effective if allergies trigger asthma • Children with documented allegries • Not for children without allergies
- 144. cromones R 1 2 34 5 IgE antagonist
Editor's Notes
- #2 We will start with 2 case presentations. I would like to see your information about asthma
- #7 Sustain your clinical diagnosis
- #10 I will tell you only the value of BNP and you will tell me if this is CF or Asthma
- #11 Prin efectul beta 1
- #12 His daughtert
- #13 No signs on physical examiation
- #25 Hyperpneea elimination of CO2 PaCO2=35-45 HCO#=24-27 PaO2>80 pH 7,35-7,45 RESPIRATORY ALCALOSIS greater than 110 indicates pt is on supplemental oxygen.
- #27 What form ? There is a clasification of Asthma
- #39 usually, the cough is nonproductive and nonparoxysmal. -children with nocturnal asthma tend to cough after midnight and during the early hours of morning.
- #43 in the mildest form, wheezing is only end expiratory. in a more severe asthmatic episode, wheezing is also present during inspiration.
- #44 Obtained at the Patient’s Bedside Other signs
- #45 Severe asthma
- #52 Total serum immunoglobulin E levels greater than 100 IU are frequently observed in patients with allergic reactions. Two methods are available to …to specific allergens in the environment
- #74 -Gastroesophageal reflux - Obstruction of the upper airways and inhalation of foreign bodies - Dysfunction of the vocal cords - Non-obstructive pulmonary diseases (diffuse interstitial pneumopathy) - Pulmonary thromboembolism - Hyperventilation syndrome and panic attack.
- #97 1 nu este necesara medicatia de fond 2. De elective corticoizi-doza mica low 3. Treapta 3: corticoizi doza moderata sau corticoizi doza mica+ betaagonisti cu durata lunga de actiune; ca si alternative este:corticoizi cu antileucotriene sau corticoizi cu teofilina retard sau corticoizi cu anticolinergice cu durata lunga (tiotropium rec) 4. Corticoizi in doza mare+beta 2 agonisti cu durata lunga de actiune sau doza mare de corticoizi sau antileucotriene sau teofilina sau anticolinergice
- #107 Neselective: adrenalina alfa=beta, isoprenalina beta1 si beta2 Selective-cele enumerate beta2>> beta1 BEROTEC VENTOLIN BRYCANIL REMINDER: Bronchodilators relieve symptoms but cannot reduce or prevent the swelling of airways that cause the symptoms. Debutul efectului la 5 minute dureaza 4 ore 4 doze/zi. OXIS TURBUHALER SEREVENT Debutul efectului la 3 ore dureaza 12 ore nu in acut ci in tratamentul cronic si profilaxia crizelor de astm ex: astmul indus de effort.
- #108 Neselective: adrenalina alfa=beta, isoprenalina beta1 si beta2 Selective-cele enumerate beta2>> beta1 BEROTEC VENTOLIN BRYCANIL REMINDER: Bronchodilators relieve symptoms but cannot reduce or prevent the swelling of airways that cause the symptoms. Debutul efectului la 5 minute dureaza 4 ore 4 doze/zi. OXIS TURBUHALER SEREVENT Debutul efectului la 3 ore dureaza 12 ore nu in acut ci in tratamentul cronic si profilaxia crizelor de astm ex: astmul indus de effort.
- #111 IPRAVENT=ipatropium bromide ATROVENT Efect in 15 minute, durata 6 ore SPIRIVA 24 ore deci nu se foloseste in urgenta
- #112 IPRAVENT=ipatropium bromide ATROVENT Efect in 15 minute, durata 6 ore SPIRIVA 24 ore deci nu se foloseste in urgenta
- #114 200 mg de 2 ori/ zi la copii si adolescenti 350 mg Theotard de 2 ori/zi
- #115 200 mg de 2 ori/ zi la copii si adolescenti 350 mg Theotard de 2 ori/zi
- #118 BECOTIDE PULMICORT FLIXOTIDE Doar pt tratament de intretinere Oral:are used for short-term treatment (3-10 d) to gain prompt control of inadequately controlled acute asthmatic episodes. I.V. corticosteroids are used in the acute phase of asthma.
- #119 BECOTIDE PULMICORT FLIXOTIDE Doar pt tratament de intretinere Oral:are used for short-term treatment (3-10 d) to gain prompt control of inadequately controlled acute asthmatic episodes. I.V. corticosteroids are used in the acute phase of asthma.
- #122 INTAL TILADE
- #123 INTAL TILADE
- #125 SINGULAIR 1/zi oraly ACCOLATE 2/zi oraly Zyflo 4/zi oraly
- #126 SINGULAIR 1/zi oraly ACCOLATE 2/zi oraly Zyflo 4/zi oraly
- #128 Nu sunt cu durata lunga beta2 si anticolinergic SERETIDE25/50 microgr 25/125 microgr 25/250 microgr Cele long-acting nu sunt eficiente in acut
- #129 Nu sunt cu durata lunga beta2 si anticolinergic SERETIDE25/50 microgr 25/125 microgr 25/250 microgr Cele long-acting nu sunt eficiente in acut
- #141 Prin efectul beta 1
- #145 1 nu este necesara medicatia de fond 2. De elective corticoizi-doza mica low 3. Treapta 3: corticoizi doza moderata sau corticoizi doza mica+ betaagonisti cu durata lunga de actiune; ca si alternative este:corticoizi cu antileucotriene sau corticoizi cu teofilina retard sau corticoizi cu anticolinergice cu durata lunga (tiotropium rec) 4. Corticoizi in doza mare+beta 2 agonisti cu durata lunga de actiune sau doza mare de corticoizi sau antileucotriene sau teofilina sau anticolinergice
- #146 You must know that asthmatics can play sports There are many asthmatics players: David Backhamp
- #147 And don’t forget Mark Spitz who won 7 gold medals in swimming in the same Olimpics who was also asthmatic.