This document discusses bronchial asthma. It begins by stating that asthma is a global health problem affecting people of all ages worldwide, with over 300 million current sufferers according to the WHO. It then discusses the prevalence of asthma in Bangladesh, defining asthma as a chronic inflammatory lung condition causing episodic airflow obstruction. The document outlines the classification, causes, triggers, pathogenesis, diagnosis and management of asthma through step-wise treatment. It emphasizes the importance of patient education to help avoid exacerbations and hospital admissions.
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
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
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.
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
This is a powerpoint presentation on Emphysema topic taken from Robin's and Cotran textbook of pathology
contans :
1) definition
2) types and pathogenesis of emphysema
3) morphology of early and advanced stage of emphysema
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.
Bronchial Asthma - Epidemiology, Pathogenesis and ManagementShashikiran Umakanth
Bronchial asthma is a chronic disease with airway inflammation as a central theme in its pathogenesis. Prevalence of this condition is gradually increasing, especially in developed countries and in countries that are getting "westernized". With early diagnosis, regular monitoring and prompt and rational treatment, most patients with asthma can lead a symptom-free life.
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,
(M) +91 97236 69210
Skype Id : cosmic1021
Email:
drmahavrat@homeopathyhealing.net
this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.
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.
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
This is a powerpoint presentation on Emphysema topic taken from Robin's and Cotran textbook of pathology
contans :
1) definition
2) types and pathogenesis of emphysema
3) morphology of early and advanced stage of emphysema
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.
Bronchial Asthma - Epidemiology, Pathogenesis and ManagementShashikiran Umakanth
Bronchial asthma is a chronic disease with airway inflammation as a central theme in its pathogenesis. Prevalence of this condition is gradually increasing, especially in developed countries and in countries that are getting "westernized". With early diagnosis, regular monitoring and prompt and rational treatment, most patients with asthma can lead a symptom-free life.
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,
(M) +91 97236 69210
Skype Id : cosmic1021
Email:
drmahavrat@homeopathyhealing.net
this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.
An old presentation that I made when I was an Intern in Pediatric department.
The presentation contains 71 slides. It discusses bronchial asthma in pediatric age group starting from the definition of bronchial asthma and its pathophysiology and ending by the management of acute attacks of asthma and long-term management of bronchial asthma patients.
Bronchial Asthma in Acute Exacerbation, Diabetes Mellitus-Type II, Hyperchole...Jack Frost
Bronchial Asthma in Acute Exacerbation, Diabetes Mellitus-Type II, Hypercholesterolemia , MANAGEMENT AND TREATMENT. This presentation contains real names of persons involve of this particular study. This names should not be copied or rewritten. Used the data of this study as basis only. All rights reserved 2009.
Asthma is a chronic inflammatory condition associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise).
Physiotherapy can provide relief from symptoms of uncontrolled asthma, including coughing, wheezing, tightness in the chest, shortness of breath and QOL.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Asthma is a global health problem. It is common in
people of all ages in countries through out the world.
According to WHO, more than 300 million people
worldwide are suffering from asthma and estimated
that there may be an additional 100 million
people with asthma by 2025.
Introduction
3. Prevalence in Bangladesh:
According to the first national asthma prevalence
study in Bangladesh, about 7 million people (5.2%)
suffering from asthma, majority of them are in 1-15
years of age group that is 7.4%of total paediatric
population is suffering from asthma.
4. What is Asthma ?
The term asthma is derived from a Greek word
meaning ‘panting’ or ‘labored breathing’.
Asthma is a chronic inflammatory condition of the
lung airways that causes episodic airflow
obstruction and airways hyper-responsiveness
to some provocative factors.
Asthma is characterized as a syndrome rather
than a disease.
5. According to the National Guideline,
Asthma is a chronic inflammatory disorder
causing hyper-responsiveness of airways to
certain stimuli resulting in recurrent variable
airflow limitation, at least partly reversible,
presenting as wheezing, breathlessness,
chest tightness and coughing.
6. What are the causes of asthma?
The exact etiology of asthma is still not known
but it is suggested that asthma is a multifactorial
disease and airway of the asthma patient are
highly sensitive to certain things which do not
bother people without asthma.
13. Pathogenesis
Airflow obstruction in asthma is the result of
numerous pathologic processes.
• In the small airways, airflow is regulated by the
encircling bronchial smooth muscle.
• Constriction of these bronchiolar muscular bands
causes restriction of airflow.
• A cellular inflammatory infiltrate and exudates
(eosinophils, mast cells, lymphocytes etc) can fill
and obstruct the airways and causes epithelial
damage and desquamation.
16. IMMEDIATE RESPONSE
Eliciting agent: allergen or
non-specific stimulus activates:
Mast cells, platelets, alveolar
macrophages, causing release of:
Spasmogens: H,
PAF, LTC4, LTD4,
causing:
Chemotaxins:
LTB4, PAF, MNC,
ECF-A which
cause:
BRONCHOSPASM
Reversed by
agonists &
Theophylline
Aggregation & activation of
platelets, infiltration & activation of
neutrophils, eosinophils,
monocytes/macrophages :
PAF, LTB4,
LTD4, platelet
factors&
susbstance P
Neurotensin
ODEMA, MUCOUS
SECRETION &
BRONCHOSPASM
LATE-PHASE RESPONSE
Bronchial
hyper
responsiven
ess
Endothelial
damage
& stimulation of
C Fibes and
irritant
receptors
17. MEDIATORS RESPONSIBLE
1ST GROUP: role in bronchospasm is clearly supported
by pharmacological interventions
• e.g. leukotrienes C4,D4,E4, acetylcholine
2nd GROUP:- have potent asthma like effects but their
actual clinical
role appears to be minor on the basis of lack of efficacy of
potent antagonists or synthesis inhibitors
• e.g. histamine, prostaglandin D2, PAF
3RD GROUP:- whose specific antagonists are not
available and even their role in asthma is not clear
• e.g. IL-1, TNF, IL-6, chemokines, nitric
oxide, bradykinin , endothelins ,neuropeptides..
18. Cont..
Consequently,
Airway hyper-responsiveness to numerous
provocative triggers, as well as airways edema,
basement membrane thickening, subepithelial
collagen deposition, smooth muscle and mucous
gland hypertrophy, and mucous hypersecretion;
all these processes contribute to airflow
obstruction.
20. A. Clinical classification:
1.Intermittent asthma: 2 or <2 nocturnal symptoms
in a month and between the episodes, patient is
symptom free & PFT normal.
2.Persistent asthma: Frequent attack >2 in a month
and in between attack, patient may or may not be
symptom free & PFT abnormal except mild
persistent variety.
21. It is further divided into three types –
a) Mild persistent: nocturnal attack of
dyspnea >2 times per month and baseline FEV1
is usually 80%-65%.
b) Moderate persistent: asthma attack
almost everyday and baseline FEV1 is between
65% – 50%.
c) Severe persistent: dyspnea to some
extent continuously for 6 months or more and
baseline FEV1 is <50%.
22. • 3. Acute exacerbation: Loss of control of any
class/ variant of asthma which may cause mild to
life threatening attack.
23. Classification of asthma contd..
Assessment of severity of acute asthma in
children
Symptoms Mild Moderate Severe
Physical
exhaustion
Talks in
Consciousness
No
Sentence
s
Consciou
s
No
Phrases
Conscious
Yes
Words
Altered
Signs
Wheeze
Pulse
Cyanosis
PEFR or FEV1
SaO2
Variable
<100
Absent
>60%
>94%
Loud
100-160
Absent
40%-60%
94%-90%
Often quiet
>160
Likely
present
<40%
<90%
26. •particularly if these symptoms:
• are frequent and recurrent
• are worse at night and early morning
• occur in response to or are worse after exercise
or other trigger
• occur apart from colds
• personal and family history of atopic disorder
30. Differential diagnosis of childhood asthma
• Foreign body aspiration
• Happy wheezers
• Post nasal drip syndrome
• Pulmonary eosinophilia
• Cystic fibrosis
31. Asthma is a clinical diagnosis.
A compatible clinical history plus a demonstration of
variable airflow obstruction is sufficient for the
diagnosis of asthma.
Diagnosis
32. Why we investigate Asthma patient
• For Classification and assessment of severity
• For diagnosis of concomitant illness
• For exclusion of other cause of cough, wheeze,
dyspnea, or chest tightness
33. 1. Lung function test:
- Spirometry-
FEV1 <80% of predicted value
FVC normal or reduced
FEV1/FVC ratio reduced <75%
- Reversibility test
- Exercise challenge test
- Diurnal variation of peak flow
cont..
34. 2. Chest X-ray- to exclude foreign body or chronic
chest infection
3. CBC with circulating eosinophil-shows
eosinophilia
4. Serum IgE -raised
Cont….
36. 4. MANAGEMENT OF ACUTE EXACERBABATION
Propped –up position
Oxygen inhalation 4-6 L/min
Nebulization with salbutamol every 20 min
interval 3 times
Injection hydrocortison(4-6mg/kg/dose stat & 6
hrly)
Add Ipratropium bromide in nebulized
form 6 hourly
No improvement
37. Add Ipratropium bromide in nebulized
form 6 hourly
Add Inj Aminophylline (5mg/kg bolus then
maintenance dose of 0.5-0.7mg/kg/hr )
or Inj salbutamol (15 µgm/kg bolus )
No improvement
No improvement
ICU Care
38. Clinical scoring to identify the steps of “ step care
management”
CRITERIA SCORE
Yes No
1. Have dyspnoea everyday? 1 0
2. Nocturnal attack of dyspnoea more than
two times per month
1 0
3. Severe dypnoea necesssitate-steroid,
Nebulization or Hospitalization
1 0
39. Clinical scoring to identify the steps of “ step care
management”
CRITERIA SCORE
Yes No
4. Persistent dyspnoea for last
6months/moreOR take steroid for 1
yr/more
3 0
5. Patients baseline PEFR <60% of
predicted value
1 0
TOTAL SCORE = 0-7 Score0= step I,
Score1= step II, Score2= step III,
Score 3-4= step IV, Score 5-7= step V
40. STEP CARE MX FOR CHILDREN >5 YEARS
Step 1 Step 2 Step 3 Step 4 Step 5 Step 6
Asthma education
Environmental control
Preferre
d
SABA as
per need
Preferred
LDICS
Alternativ
Cromone
s or
Nedocro
mil or
LTRA or
Theophyll
ine
Preffered
HDICS or
LDICS+LABA
alternative
LDICS+either
LTRA or
Theophylline
Or Cromones
Preffered
HDICS+LABA
Or theophy
or LTRA
Alternative
HDICS+Laba
or
Theophylline
Or LTRA
Preffered
HDICS
+LABA+
Theophy.
Alternativ
e
HDICS
+LTRA or
Theophylli
ne
Preffered
HDICS+
LABA+
oral
corticoste
roid
Alternativ
e
HDICS+
LTRA or
Theophyll
ine+ oral
corticoste
41. STEP CARE MX FOR CHILDREN <5 YEARS
Step
1
Step 2 Step 3 Step 4 Step 5 Step 6
Preffe
red
Inhale
d
SABA
Preferr
ed
LDICS
Alterna
tive
LTRA
or
Cromo
nes
Preffer
ed
MDIC
S
Preffere
d
MDICS+
Either
LABA or
LTRA
Preffered
HDICS+
Either
LABA or
LTRA
Preffered
HDICS+
Either
LABA or
LTRA+
Oral
corticost
eroid
42. Classification on the basis of
control(working classification)
It is important and relevant for management of
asthma.On the basis of control, asthma can be
classed as-
A. Controlled
B. Partly controlled &
C. Uncontrolled
43. Levels of asthma control:
Characteristi
c
Controlled Partly
Controlled
Uncontroll
ed
Daytime
symptoms
None≤2/wk >2/wk
Limitation of
activities
None Any ≥3 features
of partly
controlled
asthma
present
Nocturnal
symptoms/
awakening
None Any
44. Levels of asthma control:
Characteristic Controlled Partly
Controlled
Uncontroll
ed
Need for
reliever/rescue
treatment
Lung Function
None
≤2/wks
Normal
>2/wk
<80%
45. Indications of antibiotics in asthma
• Fever with purulent sputum
• Suspected bacterial sinusitis
• Patients with overlapping COPD
• Presence of concomitant pneumonia
• Frequent exacerbation of asthma ( may be
associated with mycoplasma or chlamydial
infections)
50. Newer modality of asthma therapy:
1.Magnesium sulfate:
40mg/kg I/V
2.Omalizumab:
It is the monoclonal antibody against IgE.
150-300mg, 2-4 weeks interval.
52. Follow up
•Good response criteria:
• Improvement almost complete
• No distress
• Physical examination- normal
• PEF>70% of predicted or personal best
In case of good response patient
may go home with rescue steroid and
step care management .
53. Follow up
•incomplete response criteria:
• Improvement partial
• Mild to moderate distress
• Physical examination- rhonchi
• PEF>50% - <70%
In case of incomplete response patient
Should be admitted to the hospital and
Management is to be continued.
54. Follow up
•Poor response criteria:
• No Improvement
• Severe symptom persists.
• Extensive rhonchi / silent chest
• PEF<50%
In case of poor response patient is to be
Admitted in ICU for further management.
55. Asthma education
• Patient education is so important that if they are
educated properly, 73% of hospital admission can
be reduced and 80% of death from asthma can
be avoided.
57. Asthma education
1. Basic fact about asthma:
• Concept of disease
• Concept of airway narrowing
2. Asthma medicines and appliances:
• Concept of medication
• Use of appliances
58. Asthma education
3. Concordance:
• Need for long term therapy
• Importance of asthma management plan
• Regular peak flow monitoring
• Rescue action
4. Avoidance of risk factor
59. Asthma education
5. Prognosis and goal management:
• Natural history
• Treatment goal
6. Alleviation of misconception