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Bronchial asthma
- 1. BRONCHIAL MARYAM JAMILAH BINTI ABDUL HAMID 082013100002 IMS BANGALORE
- 2. Learning outcome • define • pathophysiology • causes • clinical features • examination • investigation
- 3. Defined by presence of both:- • Excessive variation in lung function (variable airflow limitation) • respiratory symptoms (wheeze, SOB, cough, chest tightness) that vary over time Definition
- 4. Etiology
- 5. • No single cause but there are trigger factors • A-allergens; pollens,animal dander,dust mites,mould • B-bronchial infection • C-cold air, exercise • D-drugs; aspirin,NSAIDs,B-blockers • E-psychosocial problems,emotion (stress,laughter) • F-food; sodium metabisulphate,seafood,nuts,MSG • G-GERD • H-hormones; pregnancy,menstruation • I-irritants; smoke, perfumes,smells • J-job; wood dust,flour dust,isocyanates,animals
- 6. • infiltration of the mucosa with inflammatory cells (especially eosinophils) and cellular elements • airway hyper-responsiveness • intermittent airway narrowing (due to bronchoconstriction, congestion or edema of bronchial mucosa or a combination of these) Pathophysiology
- 9. classic symptoms; • wheezing • coughing (especially at night) • tightness in the chest • breathlessness Clinical features
- 10. supporting features:- (asthma is likely if >1) • symptoms recurrent or seasonal • worse at night or early morning • hx of allergies • fam. hx of asthma or allergies • widespread audible wheeze on chest auscultation • symptoms rapidly relieved by a short-acting B-agonist bronchodilator (SABA)
- 11. abse • trachea: midline • chest wall movement: decreased b/l • percussion: resonant • breath sounds: vesicular-prolonged expiration • vocal fremitus: N or decreased • adventitious sounds: expiratory wheezes Examination
- 12. • Spirometry: <75% for FEV1/VC ratio • Peak expiratory flow rate (PEFR) before & after SABA; improvement >15% in FEV1 and PEFR • Inhalation challenge tests: histamine, methacholine or hypertonic saline • Mannitol inhalation test • Exercise challenge • Allergy testing • CXR Investigations
- 17. • Murtagh’s, General Practice 6th edition • uptodate.com • Davidson’s medicine textbook References
Editor's Notes
- absence physical signs do not exclude asthma during attack, high pitched & diffuse wheezes throughout inspiration & most of expiration are prolonged if wheeze not present during N tidal breathing, asked pt. to forced expiration *absence of wheeze in dyspnic pt. indicate serious sign