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: 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.
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.
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/
Clinical features and investigations of asthma is explained in very simple wording and style. Easy to remember and present due to interesting pictures. Helpful for medical students, patients with asthma and knowledge seekers.
Clinical features and investigations of asthma is explained in very simple wording and style. Easy to remember and present due to interesting pictures. Helpful for medical students, patients with asthma and knowledge seekers.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Nursing management of the client with increased intracranial pressureANILKUMAR BR
The rigid cranial vault contains brain tissue (1,400 g), blood (75 mL), and CSF (75 mL)
The volume and pressure of these three components are usually in a state of equilibrium and produce the ICP.
ICP is usually measured in the lateral ventricles; normal ICP is 10 to 20 mm Hg. Increased ICP is a syndrome that affects many patients with acute neurologic conditions.
This is because pathologic conditions alter the relationship between intracranial volume and pressure. Although an elevated ICP is most commonly associated with head injury, it also may be seen as a secondary effect in other conditions, such as brain tumours, subarachnoid haemorrhage, and toxic and viral encephalopathies
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Or •Bronchiectasis is characterized by permanent, abnormal dilation of one or more large bronchBronchiectasis.
Anaesthetic considerations for Robotic Surgery, What to expect, how to go ahead. An update and incite on the intricacies of Robotic Surgery and Anaesthetic implications.
Regional Blocks of the Upper Limb and Thorax RRTRanjith Thampi
Blocks of the UL and Thorax made easy. Most methods mentioned here are modifications and not classical methods used that maybe be required for examination writing purpose.
Made by Ranjith R Thampi. This was a powerpoint I had made for a Cardiology Seminar during internship. Got it checked by cardiologists, all approved. Covers management of UA, NSTEMI and STEMI. This was my favorite topic. I think the flowcharts will be clear to the point. Kindly comment and let me know.
Deep Vein Thrombosis is an important and frequently missed out diagnosis that can often lead to sudden death in post operative patients. Did this powerpoint for an O&G seminar. Mainly focusses on DVT in OBG and its management and prevention. Kindly leave a comment and let me know what you think.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
- 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
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
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
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Bronchial Asthma
and
management
Ranjith. R. Thampi
CRRI
Community Medicine
2. Introduction
Asthma is one of the most common
chronic diseases in the world.
Cause for considerable economic burden from
Direct and Indirect medical costs
Most important cause of elementary school
absenteeism.
Lack of availability of drugs in many areas
around the world
Western lifestyles and urbanized communities
As urban population increases from 45 to
59%(projected for 2025), so likely marked
increase in asthma cases from 300 million to
an additional 100 million
3. Problem Statement
GLOBAL
287,000 (0.5% of total global deaths) deaths
-151,000 men and 136,000 women (WHO, 2006)
-16.7 million deaths in age 15–59 years(WHO, 2006)
-As many as 300 million people of all ages, and all ethnic
backgrounds, suffer from asthma
-The burden to governments, health care systems, families, and
patients is increasing worldwide.
-The number of disability-adjusted life years(DALYs) lost due to
asthma worldwide has been estimated to be currently about 15
million per year.
* High prevalence rates (15%–20%) in the United Kingdom, Canada,
Australia, New Zealand and other developed countries
Highest Asthma prevalence rates are in the:
United Kingdom (>15%) and New Zealand (15.1%)
4. Problem Statement
INDIA
Prevalence of Asthma 7.24% with SD 5.42 (2006)
277 DALYs per 100,000
-Constitutes 0.2% of all deaths and 0.5% of National
Burden of Diseases (Smith 2002)
-In developing regions (Africa, Central and South
America, Asia, and the Pacific), Asthma prevalence, is
rising sharply with increasing urbanisation and
westernisation (Masoli et al. 2004).
*Low prevalence rates (2%–4%) in Asian countries (especially China and
India), although reporting relatively lower rates than those in the West,
account for a huge burden in terms of absolute numbers of patients
6. Current asthma prevalence is higher
among:
– Children than Adults
–Boys than Girls
– Women than Men
Source: Impact of gender on asthma in childhood and adolescence:
a GA2LEN review
C. Almqvist1, M. Worm2, B. Leynaert3,
7. DEFINITION
Bronchial asthma is a chronic inflammatory
disorder of the airways associated with
airway hyper responsiveness
presents with:
• Wheezing
• Breathlessness
• Chest tightness
• Nighttime or early morning cough
Airway obstruction is reversible
either spontaneously or with treatment.
8. Risk Factors
• Prenatal:
Maternal smoking, stress, use of antibiotics and delivery by
Caesarean section.
• Childhood:
Allergens, environmental tobacco smoke, exposure to
animals, impaired lung function in infancy, lack of
Breastfeeding, family size and structure, socio-economic
status, infections, sex and gender.
• Occupational exposures constitute a common risk factor for Adult
asthma.
*Children of parents withetiology and risk factors- ---Canadian Medical greater morbidity from asthma
Source: Asthma: epidemiology, lower socio-economic status have Association Journal
Padmaja Subbarao, MD MSc, Piush J. Mandhane, MD PhD,Malcolm R. Sears, MB ChB
9. Risk Factors
1.Evidence suggests an
association between
environmental tobacco smoke
exposure and exacerbations of
asthma among school-aged,
older children, and adults.
2.Evidence shows an
association between
environmental tobacco smoke
exposure and asthma
development among pre-
school aged children.
Source: 1. Association between Exposure to Environmental Tobacco Smoke and Exacerbations of Asthma in Children
Barbara A. Chilmonczyk, Luis M. Salmun, Keith N. Megathlin, Louis M. Neveux, Glenn E. Palomaki, George J. Knight, Andrea J. Pulkkinen, and
James E. Haddow N Engl J Med 1993; 328:1665-1669June 10, 1993
2. Association between environmental tobaccosmoke exposure and wheezing disorders in Austrian preschool children
Elisabeth Horak a, Bernhard Morassa, Hanno Ulmerb
S W I S S M E D W K LY 2 0 0 7 ; 1 3 7 : 6 0 8 – 6 1 3 · w w w . s m w . c h
11. Clinical Scenario
• Young or middle-aged patient presenting with
progressive,
-wheezing
-breathlessness
-cough
-chest tightness
With or without a h/o exposure to allergens
12. Diagnosis
Pulse oximetry and ABG analysis
Chest Xray
Blood Test
Peak Flow meter + Spirometry-
PEFR + FEV1 decrease
PEFR + FEV1 increase >15% after
agonist inhalation
Skin Testing
14. Indicators of Severe Asthma
Anxious and diaphoretic appearance, upright position
Breathlessness at rest and inability to speak in full sentences
Tachycardia (HR>120) and Tachypnoea (RR>30)
Pulse oximetry <91% (on room air)
PaCO2 normal or increased
PEFR <150 L/min or <50% predicted
Source: Expert Panel Report 2: Guidellines for the diagnosis and management of asthma: National Institute of Health- National
Heart, Lung and Blood Institute 1997; NIH publication number 97-4051
15. Managing Asthma: Goals
• 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
18. Classification of Asthma Severity in
Children(5yrs) to Adults
[Symptom Based]
Components of Intermittent Persistent
Severity
Mild Moderate Severe
1.Symptoms =<2 days/week >2 days/week Daily Throughout
but not daily the day
2.Nighttime =<2x/month 3-4x/month >1x/week but Often
awakenings not nightly 7x/week
*3.Using Short- =<2 days/week >2 days/week Daily Several times
acting Beta2- But not daily per day
agonists for
symptom
control
4.Interference None Minor Some Limitation Extremely
with normal Limitation Limited
activity
19. Classification based on Lung
Function for Children 5-11 Yrs
Severity Intermittent Persistent
Component
Mild Moderate Severe
Normal FEV1
between
exacerbations
Lung FEV1 >80% FEV1 =>80% FEV1 =60-80% FEV1 <60%
predicted predicted predicted predicted
Function
FEV1/FVC >85% FEV1/FVC >80% FEV1/FVC FEV1/FVC <75%
= 75-80%
20. Classification based on Lung Function
for Youths >12 Yrs of age and Adults
Severity Intermittent Persistent
Component
Mild Moderate Severe
Normal FEV1
between
exacerbations
Lung
Function FEV1 >80% FEV1 =>80% FEV1 >60% but FEV1 <60%
Normal FEV1/FVC= predicted predicted <80% predicted predicted
8-19 yr 85%
20-39 yr 80%
40-59 yr 75%
60-80 yr 70%
FEV1/FVC FEV1/FVC FEV1/FVC FEV1/FVC
normal normal reduced 5% reduced >5%
21. Making it
Simple
Mild Acute Asthma:
Characterized by cough with or without wheeze, some
difficulty in respiration but no problems of speech or
feeding
Oxygen Saturation of >95% and PEFR >80% predicted
Moderate to Severe Asthma:
Characterized by tachypnoea, tachycardia, mild chest
indrawing, difficulty in feeding and speech
Oxygen Saturation may be as low as 90%, PEFR 30-
60%
Life Threatening Asthma:
Characterized by poor respiratory effort, cyanosis,
exhaustion, agiated or depressed
Oxygen Saturation low as 90%, PEFR<30%
22. Treatment steps for achieving
control
Total of 5 steps for control
Steps 1-5 provide options for increasing efficacy with exception of step 5
where issues of availability and safety INFLUENCE selection of treatment.
• Step 1- Inhaled short acting b-2 agonist as required
• Step 2- is the Initial treatment for most treatment-nai’ve patients
with persistent asthma symptoms – PLUS inhaled steroid BDP
200-800 mcg/day (400 mcg)
• Step 3- If symptoms suggest asthma is severely uncontrolled,
this step is commenced– PLUS long acting b-2
agonist(LABA)…. Assess…
Source: : Expert Panel Report 2: Guidellines for the diagnosis and management of asthma: National Institute of Health- National
Heart, Lung and Blood Institute 1997; NIH publication number 97-4051
24. Treatment steps for achieving
control
• Step 4- Persistent poor control
Increase steroid upto 2000 mcg/day PLUS LRA, SR
theophylline, Beta-2 agonist tablet
• Step 5- Continuous or Frequent use of oral steroids
Use daily steroid tablet in lowest dose providing adequate
control
Refer to Specialist
*At each treatment step, a reliever medication(Rapid onset Bronchodilator either
short or long acting) should be provided for quick relief of symptoms, however,
regular use of reliever medication is one of the elements defining uncontrolled
*
asthma,Expert Panel Report 2: Guidellines for the diagnosis and management of asthma: National Institute of Health- National
Source : and indicates that controller treatment should be increased.
Heart, Lung and Blood Institute 1997; NIH publication number 97-4051
25. Treatment:
Maintain control
• Establish a lowest step and dose that minimises cost and
maximises safety of treatment
Conversely, asthma is a variable disease and dose needs to be
adjusted peridically in response to loss of control indicated by
worsening of symptoms and exacerbation
• Frequency of healthcare visits and assessment depends on
patients clinical severity and confidence iin playing a role in
ongoing control of his/her asthma
*Usually patients are seen 1-3 months after the initial visit and every 3 months thereafter
After an exacerbation, follow-up should be offered within 2 weeks to 1 month.
26. Managing Acute Exacerbations
Main aim is to relieve airflow obstruction and hypoxaemia as quickly
as possible, and to plan prevention of future relapses.
1. Oxygen inhalation 4 L/min(6-8 children) to maintain SpO2 >90%
2. Inj. Terbutaline 10mcg/kg(7-10mcg children) [OR Inj.
Adrenaline(1:1000) 0.01 ml/kg] subcutaneously or IV (max. 40
mcg/day) every 20-30 minutes with a total of 2-3 doses
3. Inhaled Salbutamol/Terbutaline preferably by nebulizer/ MDI with
spacer with/without facemask
1-2 puffs every 2-4 minutes upto 10 puffs and repeat every 20-30
minutes
Source : Expert Panel Report 2: Guidellines for the diagnosis and management of asthma: National Institute of Health- National
Heart, Lung and Blood Institute 1997; NIH publication number 97-4051
27. Managing Acute Exacerbations
4. Ipratropium Bromide 250 mcg by nebulizer
with Salbutamol
5. Inj. Hydrocortisone 10mg/kg IV
6. Inj. Aminophylline 5 mg/kg bolus slowly followed by
0.8-1.2 mg/kg/hr slow infusion
7. Inj. Magnesium sulphate 40mg/kg in 50 ml 5% dextrose as
slow infusion over 30 minutes(?)
---- NO RESPONSE?---- ABG—X-ray chest---Serum
electrolytes
Source : Expert Panel Report 2: Guidellines for the diagnosis and management of asthma: National Institute of Health- National Heart,
Lung and Blood Institute 1997; NIH publication number 97-4051
28. Managing Asthma in
Community Setting
CS is best for Mild Exacerbations:
• Metered doses of short-acting bronchodilators delivered via an MDI,
ideally with a spacer.
*This produces atleast an equivalent improvement in lung function as the same dose
delivered via nebuliser
• Glucocorticosteroids. Oral glucocorticosteroids (0.5–1 mg/kg of
prednisolone or equivalent during a 24-h period) should be used to
treat exacerbations, especially if they develop after instituting the other short-
term treatment options recommended for loss of control
*If patients fail to respond to bronchodilator therapy, as indicated by persistent airflow obstruction,
prompt transfer to an acute care setting is recommended, especially if they are in a highrisk group.
Source: National Heart Lung and Blood Institute and WHO. Global Initiative for Asthma.
National Institute of Health, Bethesda, 1995 publication No. 95-3659, updated October 2005
31. Intermittent versus
Continuous Nebulization
Small benefit from continuous
nebulization
– Gibbs et al. Acad Emerg Med, 2000
No increased side-effects
– Moler et al. Am J Respir Crit Care Med,
1995
Reduction of staff time
– Fink et al. Respir Care 2000
• More interesting in severe exacerbations
32. Meter-Dose Inhalers
Vs. Holding Chambers
As effective as nebulizers
(Cates et al. Cochrane Database Syst Rev, 2000)
– Similar hospital admission rate
– Similar improvement in PEFR and FEV1
– Children:
• HR more important
• duration of the treatment in the ED
• Progressive administration of the
medication
• Interesting for children < 3 years
33. Anticholinergics + 2
Agonists in Children
Schuh S et al. Pediatr 1995:
– 5-17 y.o.
– FEV1, PEFR,
hospitalization stay:
• Salbutamol < salbutamol + 1
ipratropium < Salbutamol + 3
ipratropium
• More interesting in severe
exacerbations
34. Anticholinergics + 2Agonists
Meta-analyses Adults
• Rodrigo et al. Am J Med 1999
– n = 1483
– Randomized studies, double-blind,
controlled
– Results:
• Pulmonary function improvement
• Hospital admission
• Stoodley et al. Ann Emerg Med 1999
– N = 1377
– Slight clinical improvement
– No side-effects
35. Corticosteroid Use
• Corticosteroids Decrease hospital admission if administered within
1st hour:
Equal benefit of orally and IV administration-Rowe et al. Cochrane Database
Syst Rev, 2000
• Dose range from 30-400 mg methylprednisolone adequate:
– Manser et al. Cochrane Database Syst Rev, 2000
• Inhaled Vs Systemic Corticosteroids:
- (Edmonds et al. Cochrane Database Syst Rev. 2003)
– PEFR and FEV1 as compared with placebo
– as effective as systemic corticosteroids
– Combination better than systemic route alone
36. MgSO4
• Inhalation:
– Improvement in clinical score (Fischl),
PEFR, PP
– Nannini LJJr. Am J Med 2000
– Mangat HS Eur Respir J 1998
• IV:
– Boonyavorakul C. Respiratology 2000
– Rowe BH. Ann Emerg Med 2000
• admission rate in severe asthma exacerbations
37. Antibiotics
• No benefit when comparing antibiotics to placebo
Graham et al. Cochrane Database Syst Rev. 2001
• Indications: GOLD-guideline
(Pauwels et al. Respir Care 2001)
– Worsening dyspnea and cough
– Increased sputum volume and purulence
– Infiltrates on the chest X-ray
39. Prevention: Primary
• Patient awareness/education
Efficacy of patient education and parental awareness has also been shown to be
effective in individual studies from India
(Singh et al. 2002; Gupta et al. 1998; Ghosh et al. 1998; Lal et al. 1995).
• Lifestyle Modifications: Regular balanced diet and avoidance of obesity.
Short acting beta-2 agonists should be used prior to anticipated exercise, in a
patient with exercise-induced Asthma, to alleviate symptoms
(Consensus on Guidelines of Management of Clinical Asthma 2005).
• Alternative System of Medicine:
Yogic breathing exercise technique, Pranayama, was been shown to reduce in
histamine reactivity
(Singh et al. 1990).
40. Prevention: Secondary
Avoidance of precipitating factors
Avoid dusting when subject is around
Avoid using carpets, stuffed toys, open
bookshelves, smoking, chemical sprays in house. Prefer
mosquito nets to repellants
Food containing allergen to be avoided
Maintain record of daily symptoms
*Involves avoidance of allergens and nonspecific triggers when
Asthma is established.
(Custovic et al. 1998; Strachan and Cook 1998; Chalmers et al. 2002; Jindal et al.
41. References
DAVIDSON’S PRINCIPLES AND PRACTICE OF MEDICINE 21st EDN
Indian Statistics Index - www.mospi.nic.in
http://www.cdc.gov/asthma -The Centers for Disease
Control and Prevention
National Asthma Education and Prevention Program
http://www.nhlbi.nih.gov/about/naepp/
Allergy and Asthma Network/Mothers of Asthmatics, Inc.
http://www.aanma.org
Consensus Guidelines on Management of Childhood Asthma
in India. Indian Paediatrics 1999;36: 157-165
42. References
First Aid in Asthma
http://living.oneindia.in/health/disorders-
cure/2011/asthma-attack-first-aid-251011.html
www.icsi.org ICSI Ninth Edition June 2010
Global Initiative for Asthma, National Institute of
Health, Bethesda, 1995 Publication, Updated Oct.
2005- National Heart Lung and Blood Institute and
WHO.
Oxford Handbook of Clinical Medicine 8th EDN
Oxford Handbook of Critical Care 3rd END
priority is to ensure that cost-effective management approaches which have been proven to reduce morbidity and mortality are available to as many persons as possible with asthma worldwide.Direct medical costs(such as hospital admissions and cost of pharmaceuticals) and indirect medical costs(such as time lost from work and premature death).
2 studies done have shown evidence suggesting association between tobacco smoke exposure and asthma among pre-school, school-aged, older children and adults
Pulse oximetryand ABG analysis- HypoxemiaChest Xray- normal or may show increased bronchovascular markingsBlood Test- Raised Absolute eosinophil count + Elevated IgE levelsSkin Testing- may identify causative allergen