SlideShare a Scribd company logo
Bronchial asthma
Hamdi Turkey- Pulmonologist
Department of internal medicine - Taiz university
Objectives
• To know the definition of asthma
• To understand the risk factors and triggers of asthma
• To know the pathophysiology of bronchial asthma
• To know how to diagnose asthma
• To understand the management of chronic stable asthma
• To understand the management of acute asthmatic attack
Burden of Asthma
• Asthma is one of the most common chronic diseases
worldwide with an estimated 300 million affected
individuals
• Asthma is a clinical syndrome that affects 20 million
Americans and accounts for 12.7million medical visits
yearly. One third of those afflicted with asthma are
children under the age of 18 years.
• The estimated annual direct and indirect cost of
asthma care is rising dramatically and totaled
approximately $16 billion in 2001 in the United States
Celebrities with asthma
A 32 year old female
patient presented to
the Er with acute
dyspnea, dry cough
and wheezes, she gave
a history of
recurrent similar
attacks in the past,
she admitted
increasing symptoms
with exercise and dust
exposure, how would
you approach this
case?
Definition of Asthma
• A chronic inflammatory disorder of the airways in which
many cells and cellular elements play a role. The
chronic inflammation causes recurrent episodes of
wheezing, breathlessness,chest tightness, and
coughing, particularly at night and in the early
morning. These episodes are usually associated with
widespread but variable airflow obstruction that is
often reversible either spontaneously or with
treatment.
Asthma Inflammation: Cells and Mediators
Mechanisms: Asthma Inflammation
Source: Peter J. Barnes, MD
Asthma Inflammation: Cells and Mediators
Risk Factors for Asthma
• Host factors: predispose individuals to, or protect
them from, developing asthma
• Environmental factors: influence susceptibility to
development of asthma in predisposed individuals,
precipitate asthma exacerbations, and/or cause
symptoms to persist
Factors that Exacerbate Asthma
• Allergens
• Respiratory infections
• Exercise and hyperventilation
• Weather changes
• Sulfur dioxide
• Food, additives, drugs
Factors that Influence Asthma Development and Expression
Host Factors
▪Genetic
- Atopy
- Airway
hyperresponsiveness
▪Gender
▪Obesity
•Environmental Factors
• Indoor allergens
• Outdoor allergens
• Occupational sensitizers
• Tobacco smoke
• Air Pollution
• Respiratory Infections
• Diet
Asthma

Pathophysiology

Early-Phase Response
■ Peaks 30-60 minutes post exposure, subsides 30-90
minutes later
■ Characterized primarily by bronchospasm
■ Increased mucous secretion, edema formation, and
increased amounts of tenacious sputum
■ Patient experiences wheezing, cough, chest tightness, and
dyspnea
Late-Phase Response
• Characterized primarily by inflammation
• Histamine and other mediators set up a self-
sustaining cycle increasing airway reactivity causing
hyperresponsiveness to allergens and other stimuli
• Increased airway resistance leads to air trapping in
alveoli and hyperinflation of the lungs
• If airway inflammation is not treated or does not
resolve, may lead to irreversible lung damage
Is it Asthma?
• Recurrent episodes of wheezing
• Troublesome cough at night
• Cough or wheeze after exercise
• Cough, wheeze or chest tightness after exposure to
airborne allergens or pollutants
• Colds “go to the chest” or take more than 10 days to clear
Asthma Diagnosis
■ History and patterns of symptoms
■ Measurements of lung function
- Spirometry
- Peak expiratory flow
■ Measurement of airway responsiveness
■ Measurements of allergic status to identify risk factors
■ Extra measures may be required to diagnose asthma in
children 5 years and younger and the elderly
Asthma Management and Prevention Program
Goals of Long-term Management
■ Achieve and maintain control of symptoms
■ Maintain normal activity levels, including exercise
■ Maintain pulmonary function as close to normal
levels as possible
■ Prevent asthma exacerbations
■ Avoid adverse effects from asthma medications
■ Prevent asthma mortality
Asthma Management and Prevention Program

Component 1: Develop Patient/Doctor Partnership
■ Educate continually
■ Include the family
■ Provide information about asthma
■ Provide training on self-management skills
■ Emphasize a partnership among health care
providers, the patient, and the patient’s
family
Asthma Management and Prevention Program
Component 2: Identify and Reduce Exposure to Risk Factors
▪Measures to prevent the development of asthma, and asthma
exacerbations by avoiding or reducing exposure to risk factors
should be implemented wherever possible.
▪Asthma exacerbations may be caused by a variety of risk
factors – allergens, viral infections, pollutants and drugs.
▪Reducing exposure to some categories of risk factors
improves the control of asthma and reduces medications
needs.
Asthma Management and Prevention Program
Component 2: Identify and Reduce Exposure to Risk Factors
■ Reduce exposure to indoor allergens
■ Avoid tobacco smoke
■ Avoid vehicle emission
■ Identify irritants in the workplace
■ Explore role of infections on asthma development,
especially in children and young infants
Asthma Management and Prevention Program
Influenza Vaccination
▪ Influenza vaccination should be provided to
patients with asthma when vaccination of the
general population is advised
▪ However, routine influenza vaccination of
children and adults with asthma does not
appear to protect them from asthma
exacerbations or improve asthma control
Global Strategy for Asthma Management and Prevention

Clinical Control of Asthma
▪ Determine the initial level of control to
implement treatment (assess patient
impairment)

▪ Maintain control once treatment has
been implemented (assess patient risk)
Levels of Asthma Control

(Assess patient impairment)

Assessment of Future Risk (risk of exacerbations, instability, rapid decline in lung
function, side effects)
Assess Patient Risk
Features that are associated with increased risk of
adverse events in the future include:
▪ Poor clinical control
▪ Frequent exacerbations in past year
▪ Ever admission to critical care for asthma
▪Low FEV1, exposure to cigarette smoke, high dose
medications
Asthma Management and Prevention Program

Component 3: Assess,Treat and Monitor Asthma
▪ Depending on level of asthma control, the patient is
assigned to one of five treatment steps
▪ Treatment is adjusted in a continuous cycle driven by
changes in asthma control status. The cycle involves:
- Assessing Asthma Control
- Treating to Achieve Control
- Monitoring to Maintain Control
The choice of treatment should be guided by:
■ Level of asthma control
■ Current treatment
■ Pharmacological properties and availability of the
various forms of asthma treatment
■ Economic considerations
Cultural preferences and differing health care
systems need to be considered.
Controller Medications
■ Inhaled glucocorticosteroids
■ Leukotriene modifiers
■Long-acting inhaled β2-agonists in combination with
inhaled glucocorticosteroids
■ Systemic glucocorticosteroids
■ Theophylline
■ Cromones
■ Anti-IgE
Estimate Comparative Daily Dosages for Inhaled
Glucocorticosteroids by Age
Drug Low Daily Dose (μg) Medium Daily Dose (μg) High Daily Dose (μg)
> 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y
Beclomethasone 200-500 100-200 >500-1000 >200-400 >1000 >400
Budesonide 200-600 100-200 600-1000 >200-400 >1000 >400
Budesonide-Neb Inhalation
Suspension
250-500 500-1000 >1000
Ciclesonide 80 – 160 80-160 >160-320 >160-320 >320-1280 >320
Flunisolide 500-1000 500-750 >1000-2000 >750-1250 >2000 >1250
Fluticasone 100-250 100-200 >250-500 >200-500 >500 >500
Mometasone furoate 200-400 100-200 > 400-800 >200-400 >800-1200 >400
Triamcinolone acetonide 400-1000 400-800 >1000-2000 >800-1200 >2000 >1200
Reliever Medications
▪ Rapid-acting inhaled β2-agonists
▪ Systemic glucocorticosteroids
▪ Anticholinergics
▪ Theophylline
▪ Short-acting oral β2-agonists
Component 4: Asthma Management and Prevention Program
Allergen-specific Immunotherapy
■ Greatest benefit of specific immunotherapy using allergen
extracts has been obtained in the treatment of allergic
rhinitis
■ The role of specific immunotherapy in asthma is limited
■ Specific immunotherapy should be considered only after
strict environmental avoidance and pharmacologic
intervention, including inhaled glucocorticosteroids, have
failed to control asthma
■ Perform only by trained physician
controlled
partly controlled
uncontrolled
exacerbation
LEVEL OF CONTROL
maintain and find lowest controlling
step
consider stepping up to gain
control
step up until controlled
treat as exacerbation
TREATMENT OF ACTION
TREATMENT STEPS
REDUCE INCREASE
STEP
1
STEP
2
STEP
3
STEP
4
STEP
5
REDUCEINCREASE
© Global Initiative for Asthma
Shaded green - preferred controller options
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
TO STEP 4 TREATMENT, ADD
EITHER
▪Exacerbations of asthma are episodes of progressive
increase in shortness of breath, cough, wheezing, or chest
tightness
▪Exacerbations are characterized by decreases in expiratory
airflow that can be quantified and monitored by
measurement of lung function (FEV1 or PEF)
▪Severe exacerbations are potentially life-threatening and
treatment requires close supervision
Asthma Management and Prevention Program

Component 4: Manage Asthma Exacerbations
Primary therapies for exacerbations:
• Repetitive administration of rapid-acting inhaled
β2-agonist
• Early introduction of systemic glucocorticosteroids
• Oxygen supplementation
Closely monitor response to treatment with serial
measures of lung function
Asthma Management and Prevention Program

Component 4: Manage Asthma Exacerbations
http://www.ginasthma.org
© Global Initiative for Asthma

More Related Content

What's hot

Bronchial Asthma by Dr. Sookun Rajeev Kumar
Bronchial Asthma by Dr. Sookun Rajeev KumarBronchial Asthma by Dr. Sookun Rajeev Kumar
Bronchial Asthma by Dr. Sookun Rajeev Kumar
Dr. Sookun Rajeev Kumar
 
Asthma
Asthma Asthma
Asthma
Akhil Raj
 
Asthma
AsthmaAsthma
Asthma
Reynel Dan
 
19.bronchial asthma
19.bronchial asthma19.bronchial asthma
19.bronchial asthma
Dr.Manish Kumar
 
asthma management
asthma managementasthma management
asthma management
Dr. Bushra Hasan Khan
 
COPD
COPDCOPD
Asthma
AsthmaAsthma
Bronchiectasis.
Bronchiectasis.Bronchiectasis.
Bronchiectasis.
Davis Kurian
 
Bronchial asthama
Bronchial asthamaBronchial asthama
Bronchial asthama
Shyam Bhatewara
 
Bronchiectases
BronchiectasesBronchiectases
Bronchiectases
GAMANDEEP
 
5.Bronchiectasis
5.Bronchiectasis5.Bronchiectasis
5.Bronchiectasisghalan
 
Respiratory failure
Respiratory failureRespiratory failure
Respiratory failure
ANJANI WALIA
 
Asthma
Asthma Asthma
Acute respiratory distress syndrome (ards)
Acute respiratory distress syndrome (ards)Acute respiratory distress syndrome (ards)
Acute respiratory distress syndrome (ards)Sarath Menon
 
Pneumonia
PneumoniaPneumonia
Pneumonia
Kamal Bharathi
 
ARDS ppt
ARDS pptARDS ppt
ARDS ppt
Sanjay Peerapur
 
Management of acute asthma
Management of acute asthmaManagement of acute asthma
Management of acute asthma
Gnandas Barman
 

What's hot (20)

Bronchial Asthma by Dr. Sookun Rajeev Kumar
Bronchial Asthma by Dr. Sookun Rajeev KumarBronchial Asthma by Dr. Sookun Rajeev Kumar
Bronchial Asthma by Dr. Sookun Rajeev Kumar
 
Asthma
Asthma Asthma
Asthma
 
Asthma
AsthmaAsthma
Asthma
 
Asthma
AsthmaAsthma
Asthma
 
19.bronchial asthma
19.bronchial asthma19.bronchial asthma
19.bronchial asthma
 
asthma management
asthma managementasthma management
asthma management
 
COPD
COPDCOPD
COPD
 
Asthma
AsthmaAsthma
Asthma
 
Bronchiectasis.
Bronchiectasis.Bronchiectasis.
Bronchiectasis.
 
Bronchial asthama
Bronchial asthamaBronchial asthama
Bronchial asthama
 
Bronchiectases
BronchiectasesBronchiectases
Bronchiectases
 
5.Bronchiectasis
5.Bronchiectasis5.Bronchiectasis
5.Bronchiectasis
 
Respiratory failure
Respiratory failureRespiratory failure
Respiratory failure
 
Asthma
Asthma Asthma
Asthma
 
Acute respiratory distress syndrome (ards)
Acute respiratory distress syndrome (ards)Acute respiratory distress syndrome (ards)
Acute respiratory distress syndrome (ards)
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
COPD
COPD COPD
COPD
 
ARDS ppt
ARDS pptARDS ppt
ARDS ppt
 
Hemoptysis
HemoptysisHemoptysis
Hemoptysis
 
Management of acute asthma
Management of acute asthmaManagement of acute asthma
Management of acute asthma
 

Viewers also liked

Bronchial asthma and management RRT
Bronchial asthma and management  RRTBronchial asthma and management  RRT
Bronchial asthma and management RRT
Ranjith Thampi
 
Management of Bronchial Asthma
Management of Bronchial AsthmaManagement of Bronchial Asthma
Management of Bronchial AsthmaPk Doctors
 
Bronchial asthma
Bronchial asthmaBronchial asthma
Bronchial asthma
ANILKUMAR BR
 
Bronchial asthma
Bronchial asthmaBronchial asthma
Bronchial asthma
Prasad CSBR
 
Asthma ppt
Asthma pptAsthma ppt
Asthma and antiasthmatics
Asthma and antiasthmaticsAsthma and antiasthmatics
Asthma and antiasthmaticsDr.Vijay Talla
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolismTeleClinEd
 
астма
астмаастма
астма
Julia Ivanova
 
MANAGEMENT OF ACUTE SEVERE ASTHMA
MANAGEMENT OF ACUTE SEVERE ASTHMAMANAGEMENT OF ACUTE SEVERE ASTHMA
MANAGEMENT OF ACUTE SEVERE ASTHMAMac Rupakheti
 
Paediatric Emergencies
Paediatric EmergenciesPaediatric Emergencies
Paediatric Emergencies
Samarnath Sen
 
Acute Respiratory Illness(Ari)
Acute Respiratory Illness(Ari)Acute Respiratory Illness(Ari)
Acute Respiratory Illness(Ari)parth guragain
 
Bronchitis ppt
Bronchitis pptBronchitis ppt
Bronchitis ppt
Dr Mahavrat Patel
 
Pneumonia management
Pneumonia managementPneumonia management
Pneumonia management
Askadockenya
 
Asthma ppt
Asthma pptAsthma ppt
Asthma ppt
Namdeo Shinde
 

Viewers also liked (20)

Asthma
Asthma Asthma
Asthma
 
Bronchial asthma and management RRT
Bronchial asthma and management  RRTBronchial asthma and management  RRT
Bronchial asthma and management RRT
 
Management of Bronchial Asthma
Management of Bronchial AsthmaManagement of Bronchial Asthma
Management of Bronchial Asthma
 
Bronchial asthma
Bronchial asthmaBronchial asthma
Bronchial asthma
 
Asthma
AsthmaAsthma
Asthma
 
10. asthma
10. asthma10. asthma
10. asthma
 
Bronchial asthma
Bronchial asthmaBronchial asthma
Bronchial asthma
 
Bronchiectasis
BronchiectasisBronchiectasis
Bronchiectasis
 
Asthma ppt
Asthma pptAsthma ppt
Asthma ppt
 
Asthma and antiasthmatics
Asthma and antiasthmaticsAsthma and antiasthmatics
Asthma and antiasthmatics
 
Pulmonary embolism
Pulmonary embolismPulmonary embolism
Pulmonary embolism
 
астма
астмаастма
астма
 
багтраа
багтраабагтраа
багтраа
 
MANAGEMENT OF ACUTE SEVERE ASTHMA
MANAGEMENT OF ACUTE SEVERE ASTHMAMANAGEMENT OF ACUTE SEVERE ASTHMA
MANAGEMENT OF ACUTE SEVERE ASTHMA
 
Paediatric Emergencies
Paediatric EmergenciesPaediatric Emergencies
Paediatric Emergencies
 
Asthma
AsthmaAsthma
Asthma
 
Acute Respiratory Illness(Ari)
Acute Respiratory Illness(Ari)Acute Respiratory Illness(Ari)
Acute Respiratory Illness(Ari)
 
Bronchitis ppt
Bronchitis pptBronchitis ppt
Bronchitis ppt
 
Pneumonia management
Pneumonia managementPneumonia management
Pneumonia management
 
Asthma ppt
Asthma pptAsthma ppt
Asthma ppt
 

Similar to Bronchial asthma

seminar-gina mengenai asma, guidline panduan
seminar-gina mengenai asma, guidline panduanseminar-gina mengenai asma, guidline panduan
seminar-gina mengenai asma, guidline panduan
skuymufid
 
gina guidelines 2015 asthama
gina guidelines 2015 asthamagina guidelines 2015 asthama
gina guidelines 2015 asthamaJegon Varakala
 
Asthma and therapeutics
Asthma and therapeuticsAsthma and therapeutics
Asthma and therapeutics
Koppala RVS Chaitanya
 
Bronchial Asthma 2022.pptx
Bronchial Asthma 2022.pptxBronchial Asthma 2022.pptx
Bronchial Asthma 2022.pptx
drperumal
 
Childhood asthma
Childhood asthmaChildhood asthma
Childhood asthmaAjay Vaid
 
CME Asthma FINAL.pptx
CME Asthma FINAL.pptxCME Asthma FINAL.pptx
CME Asthma FINAL.pptx
MohamadAsyrafMohdRos3
 
Management of Chronic Asthma2-1.ppt
Management of Chronic Asthma2-1.pptManagement of Chronic Asthma2-1.ppt
Management of Chronic Asthma2-1.ppt
Kemi Adaramola
 
Gina 2019
Gina 2019Gina 2019
Asthma
AsthmaAsthma
Asthma
Hend Hassan
 
Asthma
AsthmaAsthma
Asthma
Nada Mansey
 
ASTHMA GINA CLASSIFICATION
ASTHMA GINA CLASSIFICATIONASTHMA GINA CLASSIFICATION
ASTHMA GINA CLASSIFICATION
DJ CrissCross
 
2 Global Strategy for Asthma Management
2 Global Strategy for Asthma Management2 Global Strategy for Asthma Management
2 Global Strategy for Asthma Management
Yaser Ammar
 
Bronchial Asthma in children .pptx
Bronchial Asthma in children .pptxBronchial Asthma in children .pptx
Bronchial Asthma in children .pptx
Azad Haleem
 
3. Asthma-1.pptx
3. Asthma-1.pptx3. Asthma-1.pptx
3. Asthma-1.pptx
SalimMumba
 
Theophyllin in Asthma Patient
Theophyllin in Asthma PatientTheophyllin in Asthma Patient
Theophyllin in Asthma Patient
Rodolfo Rafael
 
Asthma.pptx
Asthma.pptxAsthma.pptx
Asthma.pptx
MishraAnup1
 
Asthma Guide for Management
Asthma Guide for ManagementAsthma Guide for Management
Asthma Guide for Managementmeducationdotnet
 
Asthma
AsthmaAsthma
Asthma presentation by dr.bagasi
Asthma presentation by dr.bagasi Asthma presentation by dr.bagasi
Asthma presentation by dr.bagasi
Abdulaziz Bagasi
 
asthma Etiology/ pathophysiology /Diagnosis M
asthma Etiology/ pathophysiology /Diagnosis Masthma Etiology/ pathophysiology /Diagnosis M
asthma Etiology/ pathophysiology /Diagnosis M
Dr. Mohammad Abas Reshi
 

Similar to Bronchial asthma (20)

seminar-gina mengenai asma, guidline panduan
seminar-gina mengenai asma, guidline panduanseminar-gina mengenai asma, guidline panduan
seminar-gina mengenai asma, guidline panduan
 
gina guidelines 2015 asthama
gina guidelines 2015 asthamagina guidelines 2015 asthama
gina guidelines 2015 asthama
 
Asthma and therapeutics
Asthma and therapeuticsAsthma and therapeutics
Asthma and therapeutics
 
Bronchial Asthma 2022.pptx
Bronchial Asthma 2022.pptxBronchial Asthma 2022.pptx
Bronchial Asthma 2022.pptx
 
Childhood asthma
Childhood asthmaChildhood asthma
Childhood asthma
 
CME Asthma FINAL.pptx
CME Asthma FINAL.pptxCME Asthma FINAL.pptx
CME Asthma FINAL.pptx
 
Management of Chronic Asthma2-1.ppt
Management of Chronic Asthma2-1.pptManagement of Chronic Asthma2-1.ppt
Management of Chronic Asthma2-1.ppt
 
Gina 2019
Gina 2019Gina 2019
Gina 2019
 
Asthma
AsthmaAsthma
Asthma
 
Asthma
AsthmaAsthma
Asthma
 
ASTHMA GINA CLASSIFICATION
ASTHMA GINA CLASSIFICATIONASTHMA GINA CLASSIFICATION
ASTHMA GINA CLASSIFICATION
 
2 Global Strategy for Asthma Management
2 Global Strategy for Asthma Management2 Global Strategy for Asthma Management
2 Global Strategy for Asthma Management
 
Bronchial Asthma in children .pptx
Bronchial Asthma in children .pptxBronchial Asthma in children .pptx
Bronchial Asthma in children .pptx
 
3. Asthma-1.pptx
3. Asthma-1.pptx3. Asthma-1.pptx
3. Asthma-1.pptx
 
Theophyllin in Asthma Patient
Theophyllin in Asthma PatientTheophyllin in Asthma Patient
Theophyllin in Asthma Patient
 
Asthma.pptx
Asthma.pptxAsthma.pptx
Asthma.pptx
 
Asthma Guide for Management
Asthma Guide for ManagementAsthma Guide for Management
Asthma Guide for Management
 
Asthma
AsthmaAsthma
Asthma
 
Asthma presentation by dr.bagasi
Asthma presentation by dr.bagasi Asthma presentation by dr.bagasi
Asthma presentation by dr.bagasi
 
asthma Etiology/ pathophysiology /Diagnosis M
asthma Etiology/ pathophysiology /Diagnosis Masthma Etiology/ pathophysiology /Diagnosis M
asthma Etiology/ pathophysiology /Diagnosis M
 

More from Hamdi Turkey

Practical approach to interstitial lung diseases
Practical approach to interstitial lung diseases Practical approach to interstitial lung diseases
Practical approach to interstitial lung diseases
Hamdi Turkey
 
Pneumoconiosis
PneumoconiosisPneumoconiosis
Pneumoconiosis
Hamdi Turkey
 
Pulmonary Tuberculosis
Pulmonary Tuberculosis Pulmonary Tuberculosis
Pulmonary Tuberculosis
Hamdi Turkey
 
community acquired pneumonia (CAP)
community acquired pneumonia (CAP) community acquired pneumonia (CAP)
community acquired pneumonia (CAP)
Hamdi Turkey
 
BASIC CONCEPTS IN LUNG DISEASE
BASIC CONCEPTS IN LUNG DISEASEBASIC CONCEPTS IN LUNG DISEASE
BASIC CONCEPTS IN LUNG DISEASE
Hamdi Turkey
 
Bronchiectasis
BronchiectasisBronchiectasis
Bronchiectasis
Hamdi Turkey
 
COPD
COPDCOPD
Updates on Acute respiratory distress syndrome
Updates on Acute respiratory distress syndromeUpdates on Acute respiratory distress syndrome
Updates on Acute respiratory distress syndrome
Hamdi Turkey
 

More from Hamdi Turkey (8)

Practical approach to interstitial lung diseases
Practical approach to interstitial lung diseases Practical approach to interstitial lung diseases
Practical approach to interstitial lung diseases
 
Pneumoconiosis
PneumoconiosisPneumoconiosis
Pneumoconiosis
 
Pulmonary Tuberculosis
Pulmonary Tuberculosis Pulmonary Tuberculosis
Pulmonary Tuberculosis
 
community acquired pneumonia (CAP)
community acquired pneumonia (CAP) community acquired pneumonia (CAP)
community acquired pneumonia (CAP)
 
BASIC CONCEPTS IN LUNG DISEASE
BASIC CONCEPTS IN LUNG DISEASEBASIC CONCEPTS IN LUNG DISEASE
BASIC CONCEPTS IN LUNG DISEASE
 
Bronchiectasis
BronchiectasisBronchiectasis
Bronchiectasis
 
COPD
COPDCOPD
COPD
 
Updates on Acute respiratory distress syndrome
Updates on Acute respiratory distress syndromeUpdates on Acute respiratory distress syndrome
Updates on Acute respiratory distress syndrome
 

Recently uploaded

Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
greendigital
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
kevinkariuki227
 
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in StockFactory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
rebeccabio
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
MedicoseAcademics
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
Dr. Vinay Pareek
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Oleg Kshivets
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
Sujoy Dasgupta
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
DrSathishMS1
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Savita Shen $i11
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Catherine Liao
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
DR SETH JOTHAM
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
Anurag Sharma
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Catherine Liao
 
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyayaCharaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Dr KHALID B.M
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
GL Anaacs
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Saeid Safari
 

Recently uploaded (20)

Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
 
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in StockFactory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
 
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyayaCharaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
 

Bronchial asthma

  • 1. Bronchial asthma Hamdi Turkey- Pulmonologist Department of internal medicine - Taiz university
  • 2. Objectives • To know the definition of asthma • To understand the risk factors and triggers of asthma • To know the pathophysiology of bronchial asthma • To know how to diagnose asthma • To understand the management of chronic stable asthma • To understand the management of acute asthmatic attack
  • 3. Burden of Asthma • Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals • Asthma is a clinical syndrome that affects 20 million Americans and accounts for 12.7million medical visits yearly. One third of those afflicted with asthma are children under the age of 18 years. • The estimated annual direct and indirect cost of asthma care is rising dramatically and totaled approximately $16 billion in 2001 in the United States
  • 5. A 32 year old female patient presented to the Er with acute dyspnea, dry cough and wheezes, she gave a history of recurrent similar attacks in the past, she admitted increasing symptoms with exercise and dust exposure, how would you approach this case?
  • 6. Definition of Asthma • A chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation causes recurrent episodes of wheezing, breathlessness,chest tightness, and coughing, particularly at night and in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.
  • 10. Risk Factors for Asthma • Host factors: predispose individuals to, or protect them from, developing asthma • Environmental factors: influence susceptibility to development of asthma in predisposed individuals, precipitate asthma exacerbations, and/or cause symptoms to persist
  • 11. Factors that Exacerbate Asthma • Allergens • Respiratory infections • Exercise and hyperventilation • Weather changes • Sulfur dioxide • Food, additives, drugs
  • 12. Factors that Influence Asthma Development and Expression Host Factors ▪Genetic - Atopy - Airway hyperresponsiveness ▪Gender ▪Obesity •Environmental Factors • Indoor allergens • Outdoor allergens • Occupational sensitizers • Tobacco smoke • Air Pollution • Respiratory Infections • Diet
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Asthma
 Pathophysiology Early-Phase Response ■ Peaks 30-60 minutes post exposure, subsides 30-90 minutes later ■ Characterized primarily by bronchospasm ■ Increased mucous secretion, edema formation, and increased amounts of tenacious sputum ■ Patient experiences wheezing, cough, chest tightness, and dyspnea
  • 18. Late-Phase Response • Characterized primarily by inflammation • Histamine and other mediators set up a self- sustaining cycle increasing airway reactivity causing hyperresponsiveness to allergens and other stimuli • Increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs • If airway inflammation is not treated or does not resolve, may lead to irreversible lung damage
  • 19. Is it Asthma? • Recurrent episodes of wheezing • Troublesome cough at night • Cough or wheeze after exercise • Cough, wheeze or chest tightness after exposure to airborne allergens or pollutants • Colds “go to the chest” or take more than 10 days to clear
  • 20. Asthma Diagnosis ■ History and patterns of symptoms ■ Measurements of lung function - Spirometry - Peak expiratory flow ■ Measurement of airway responsiveness ■ Measurements of allergic status to identify risk factors ■ Extra measures may be required to diagnose asthma in children 5 years and younger and the elderly
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40. Asthma Management and Prevention Program Goals of Long-term Management ■ Achieve and maintain control of symptoms ■ Maintain normal activity levels, including exercise ■ Maintain pulmonary function as close to normal levels as possible ■ Prevent asthma exacerbations ■ Avoid adverse effects from asthma medications ■ Prevent asthma mortality
  • 41. Asthma Management and Prevention Program
 Component 1: Develop Patient/Doctor Partnership ■ Educate continually ■ Include the family ■ Provide information about asthma ■ Provide training on self-management skills ■ Emphasize a partnership among health care providers, the patient, and the patient’s family
  • 42. Asthma Management and Prevention Program Component 2: Identify and Reduce Exposure to Risk Factors ▪Measures to prevent the development of asthma, and asthma exacerbations by avoiding or reducing exposure to risk factors should be implemented wherever possible. ▪Asthma exacerbations may be caused by a variety of risk factors – allergens, viral infections, pollutants and drugs. ▪Reducing exposure to some categories of risk factors improves the control of asthma and reduces medications needs.
  • 43. Asthma Management and Prevention Program Component 2: Identify and Reduce Exposure to Risk Factors ■ Reduce exposure to indoor allergens ■ Avoid tobacco smoke ■ Avoid vehicle emission ■ Identify irritants in the workplace ■ Explore role of infections on asthma development, especially in children and young infants
  • 44. Asthma Management and Prevention Program Influenza Vaccination ▪ Influenza vaccination should be provided to patients with asthma when vaccination of the general population is advised ▪ However, routine influenza vaccination of children and adults with asthma does not appear to protect them from asthma exacerbations or improve asthma control
  • 45. Global Strategy for Asthma Management and Prevention
 Clinical Control of Asthma ▪ Determine the initial level of control to implement treatment (assess patient impairment) ▪ Maintain control once treatment has been implemented (assess patient risk)
  • 46. Levels of Asthma Control
 (Assess patient impairment)
 Assessment of Future Risk (risk of exacerbations, instability, rapid decline in lung function, side effects)
  • 47. Assess Patient Risk Features that are associated with increased risk of adverse events in the future include: ▪ Poor clinical control ▪ Frequent exacerbations in past year ▪ Ever admission to critical care for asthma ▪Low FEV1, exposure to cigarette smoke, high dose medications
  • 48. Asthma Management and Prevention Program
 Component 3: Assess,Treat and Monitor Asthma ▪ Depending on level of asthma control, the patient is assigned to one of five treatment steps ▪ Treatment is adjusted in a continuous cycle driven by changes in asthma control status. The cycle involves: - Assessing Asthma Control - Treating to Achieve Control - Monitoring to Maintain Control
  • 49. The choice of treatment should be guided by: ■ Level of asthma control ■ Current treatment ■ Pharmacological properties and availability of the various forms of asthma treatment ■ Economic considerations Cultural preferences and differing health care systems need to be considered.
  • 50. Controller Medications ■ Inhaled glucocorticosteroids ■ Leukotriene modifiers ■Long-acting inhaled β2-agonists in combination with inhaled glucocorticosteroids ■ Systemic glucocorticosteroids ■ Theophylline ■ Cromones ■ Anti-IgE
  • 51. Estimate Comparative Daily Dosages for Inhaled Glucocorticosteroids by Age Drug Low Daily Dose (μg) Medium Daily Dose (μg) High Daily Dose (μg) > 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y Beclomethasone 200-500 100-200 >500-1000 >200-400 >1000 >400 Budesonide 200-600 100-200 600-1000 >200-400 >1000 >400 Budesonide-Neb Inhalation Suspension 250-500 500-1000 >1000 Ciclesonide 80 – 160 80-160 >160-320 >160-320 >320-1280 >320 Flunisolide 500-1000 500-750 >1000-2000 >750-1250 >2000 >1250 Fluticasone 100-250 100-200 >250-500 >200-500 >500 >500 Mometasone furoate 200-400 100-200 > 400-800 >200-400 >800-1200 >400 Triamcinolone acetonide 400-1000 400-800 >1000-2000 >800-1200 >2000 >1200
  • 52. Reliever Medications ▪ Rapid-acting inhaled β2-agonists ▪ Systemic glucocorticosteroids ▪ Anticholinergics ▪ Theophylline ▪ Short-acting oral β2-agonists
  • 53. Component 4: Asthma Management and Prevention Program Allergen-specific Immunotherapy ■ Greatest benefit of specific immunotherapy using allergen extracts has been obtained in the treatment of allergic rhinitis ■ The role of specific immunotherapy in asthma is limited ■ Specific immunotherapy should be considered only after strict environmental avoidance and pharmacologic intervention, including inhaled glucocorticosteroids, have failed to control asthma ■ Perform only by trained physician
  • 54. controlled partly controlled uncontrolled exacerbation LEVEL OF CONTROL maintain and find lowest controlling step consider stepping up to gain control step up until controlled treat as exacerbation TREATMENT OF ACTION TREATMENT STEPS REDUCE INCREASE STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 REDUCEINCREASE © Global Initiative for Asthma
  • 55.
  • 56. Shaded green - preferred controller options TO STEP 3 TREATMENT, SELECT ONE OR MORE: TO STEP 4 TREATMENT, ADD EITHER
  • 57.
  • 58.
  • 59. ▪Exacerbations of asthma are episodes of progressive increase in shortness of breath, cough, wheezing, or chest tightness ▪Exacerbations are characterized by decreases in expiratory airflow that can be quantified and monitored by measurement of lung function (FEV1 or PEF) ▪Severe exacerbations are potentially life-threatening and treatment requires close supervision Asthma Management and Prevention Program
 Component 4: Manage Asthma Exacerbations
  • 60. Primary therapies for exacerbations: • Repetitive administration of rapid-acting inhaled β2-agonist • Early introduction of systemic glucocorticosteroids • Oxygen supplementation Closely monitor response to treatment with serial measures of lung function Asthma Management and Prevention Program
 Component 4: Manage Asthma Exacerbations
  • 61.
  • 62.
  • 63.