These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Made by Ranjith R Thampi. A decent powerpoint on Bronchial Asthma, a short summary on various presentations and treatment options starting at Primary health level. Was made mainly for Primary Health setup. I've also added options at higher centres and also a few references for latest drug modalities and use.
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Made by Ranjith R Thampi. A decent powerpoint on Bronchial Asthma, a short summary on various presentations and treatment options starting at Primary health level. Was made mainly for Primary Health setup. I've also added options at higher centres and also a few references for latest drug modalities and use.
Bronchitis is an acute inflammation of the air passages within the lungs. It occurs when the trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed because of infection or irritation from certain causes. Homeopathy is the best treatment with no side effects. For further information contact Ph. : +91-265-2250212,
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Asthma is a lung disorder that interferes with breathing. It can cause serious, recurring episodes of wheezing and breathlessness, known as asthma attacks. The trouble stems from chronic inflammation in the tubes that carry air to the lungs. While there is no cure, there are highly effective strategies for keeping asthma symptoms at bay.
Asthma is a lung disorder that interferes with breathing.It can appear at any age, but it typically develops during childhood. Those most at risk include people with allergies or a family history of asthma.About 1.4 million patients visit a hospital outpatient department for asthma; almost 1.75 million go to a hospital emergency room.Many people with asthma manage the condition well and can live a healthy and productive life by avoiding triggers and following their allergists’ instructions. If left unmanaged or misdiagnosed, asthma can be fatal; about 3,300 people die from it annually.
Asthma is a serious public health problem throughout the world, affecting people of all ages. When uncontrolled, asthma can place severe limits on daily life, and is sometimes fatal.
Asthma: Understanding, Managing, and Thriving
Join us on an informative journey into the world of asthma. This SlideShare presentation sheds light on the complexities of asthma, offering a comprehensive understanding of its triggers, symptoms, management strategies, and the latest advancements in treatment.
From unraveling the basics to exploring cutting-edge research, this presentation aims to equip you with actionable insights for better asthma management. Discover the importance of early diagnosis, lifestyle adjustments, and the role of healthcare providers in navigating this chronic respiratory condition.
Through engaging visuals, key statistics, and clear explanations, we'll delve into the intricacies of asthma, empowering you with knowledge to embrace a proactive approach towards a healthier life.
Whether you're someone managing asthma, a caregiver, or seeking to broaden your understanding, this SlideShare presentation is designed to inform, inspire, and encourage positive action in the realm of asthma management.
Let’s journey together towards a future where asthma doesn't limit lives but instead empowers individuals to breathe freely and live to their fullest potential.
Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms like wheezing, coughing, shortness of breath, and chest tightness. It can be triggered by various factors including allergens, respiratory infections, exercise, smoke, and pollutants. Management involves medication, identifying triggers, creating an action plan, monitoring symptoms, staying active, maintaining a healthy lifestyle, getting vaccinated, and regular check-ups with healthcare providers. Effective management aims to control symptoms, prevent flare-ups, and improve overall quality of life.
Practical approach to interstitial lung diseases Hamdi Turkey
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
It contains :
- Notes on Embryology, Anatomy and Physiology of respiratory system
- Cardinal symptoms in respiratory diseases
- Diagnostic procedures
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These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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AND
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These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
It contains :
- The new GOLD classification of severity
- The new GOLD treatment guidelines for the treatment of
COPD
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Updates on Acute respiratory distress syndromeHamdi Turkey
These lecture notes were made by Dr. Hamdi Turkey (Pulmonologist at Taiz university)
** Contents:
- Historical view on ARDS
- New definition of ARDS
- Precipitating risk factors
- Pathophysiology of ARDS
- Clinical picture, Diagnosis, Management and Prognosis
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
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
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.
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
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