1. Pulmonary Disease ASTHMA A chronic inflammatory pulmonary disease consisting of recurrent episodes of dyspnea, coughing, and wheezing result from hyperresponsiveness of the tracheobronchial tree following exposure to allergen or stress
2. Asthma In U.S., asthma is: 1) most common chronic disease of childhood affecting 5 million children < 18 yrs, 2) leading cause of school absenteeism, 3) most frequent reason for preventable hospitalization in children, 4) More often occurs in young males and older females MMWR 9/20/96 and MMWR 8/8/97 It is the 4th leading cause of disability in children Prevalence rates are highest among children residing in inner cities; mortality highest in the poor and black populations. Estimated medical costs of asthma in US increased from 4.5 billion to 6.2 billion which represents 1 to 2% of total U.S. health-care costs 1.8 million emergency room visits, 466,000 hospitalizations, and 5000 deaths occur annually in US A
11. What are warning signs of asthma attack? Anticipatory Features Restlessness during sleep Fatigue that isn't related to working or playing hard
12. Warning Signs of an Asthma Attack Irregular breathing: wheezing, labored breathing, cough Dyspnea, chest tightness Drop in FEV (<50% of optimum) Tachypnea, tachycardia Diaphoresis – sweating and paleness Pulsus paradoxus (decline > 10 mm Hg in blood pressure during inspiration compared to expiration)
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16. Asthma – Classification Frequent/daily exacerbations,continual symptoms Frequent nocturnal asthma (>4/month), exercise intolerance, FEV 1 < 60% predicted, often hospitalized Severe Persistent Daily symptoms of wheezing (over several days) Daily use of SA beta-agonist, attacks that affect activity and sleep and may last for days, nocturnal attacks at least 1/week, limited exercise tolerance, ER visit, FEV 1 60% to 80% of predicted Moderate Persistent Wheezing 2-5 days per week (over several days) Attacks that affect activity and sleep, nocturnal attacks > 2 X month, limited exercise tolerance, rare ER visit, FEV 1 > 80% predicted Mild Persistent Intermittent wheezing less than 2 days per week Brief exacerbations, asymptomatic between, nocturnal symptoms < 2 times a month, good exercise tolerance FEV 1 > 80% predicted Mild Intermittent Findings Classification
24. Additional Treatment approaches Systemic steroids +/- cyclosporine or methotrexate NEW: Recombinant injectable humanized monoclonal antibody that binds IgE ( Omalizumab [Xolair]; SubQ; Genetech/Novartis ) prevents IgE from binding mast cell/basophil receptors effective in treating adults and children with asthma allowed for withdrawal of inhaled steroids successfully in 55% of asthmatics (ADES HA, fever, urticaria and pruritis)
25. Managing Asthma -Moderate Persistent Long-term Control vs. Inhaled anti-inflammatory or corticosteroids 200-500 mg initially up to 1000 mg daily especially at night, + bronchodilator (theophylline SR, long-acting beta agonist (3-4 x d) Quick Relief Short acting bronchodilator Beta 2 -agonist Epinephrine
26. Managing Asthma -Severe Persistent Long-term Control: Inhaled anti-inflammatory (i.e., corticosteroids 200-500 mg initially up to 1000 mg daily especially at night, + bronchodilator (theophylline SR, long-acting beta agonist) + inhaled corticosteroids then tablets or syrup as needed Quick Relief Short acting bronchodilator Beta 2 -agonist + additional supportive measures as needed
