This document provides information on asthma, including its definition, types, pathophysiology, etiology, symptoms, diagnosis, and treatment. Asthma is defined as a chronic inflammatory disease of the airways characterized by variable airflow obstruction and airway hyperresponsiveness. It discusses the different types of asthma including allergic, non-allergic, cough variant, occupational, and exercise-induced asthma. Treatment involves both controller medications to reduce inflammation and reliver medications for acute symptoms. Treatment is escalated in steps based on asthma severity and control.

1. Dr. Sookun Rajeev K
(MD)
Dept of General Medicine
Anna Medical College

2. Definition:
Asthma is a disease characterised by:
 Chronic Airway Inflammation
Increased Airway Responsiveness
Airways Obstruction
Variable over Short Periods of Time
Reversible with Treatment

3. 1.Allergic asthma (extrinsic)
2.Non-allergic asthma (intrinsic)
3.Cough variant asthma
4.Occupational asthma
5.Exercise induced asthma
6.Medication induced asthma
7.Nocturnal asthma
Types Of Asthma

4. Inflammation
of inner lining
of airways
Muscle around
airways tighten
Airways produce
mucus due to
inflammation
(clogged the
shrunken tubes)
Pathology

5. Pathophysiology
•Acute Asthma Airway Obstruction
V/Q mismatch
Hypoxemia
Ventilation
PaCO2 / pH & Fatigue
Ventilation PaCO2/ pH

8. Etiology Of Asthma
Genetic factors
Environmental factors
a) House dust mites
b) Exposure to tobacco smoke.
c) Predisposed to animals, pollens moulds and dust.
Dietary changes – junk food and fast food contain
MonoSodium Glutamate

9. Etiology Of Asthma
Atopic diseases – eczema and allergic rhinitis.
Maternal status – both physical and mental
conditions like anaemia and depression in the
mother are associated with asthmatic stress for
the child.
Early antibiotic use – babies who are given
antibiotics may be 50% more likely to develop
asthma by the age of six

10. Common Triggering Factors
Extrinsic (Allergic) Triggers:
 Dust mites
 Mould
 Certain foods
 Animal dander
 Pollen
Intrinsic (Non-Allergic) Triggers:
 Exercise
 Infections (cold and flu)
 Cold or humid air
 Intense emotions (ex. Stress)
 Medications (aspirin)
 Hormones
 Air pollution
 Fragrances and chemicals
 Occupational irritants

11. Common symptoms of asthma
1.Coughing, especially at night
2.Wheezing
3.Shortness of breath
4.Chest tightness, pain, or pressure
Signs & Symptoms

12. Mild Asthma attack
1. Cough
2. Wheezing
3. Mild difficulty breathing during normal activities
4. Difficulty sleeping
5. Hiccups
6. Peak expiratory flow rate (PEFR) is 70 to 90% of
personal best
Symptoms of Asthma attack

13. Moderate asthma attack
1. Severe cough
2. Moderate wheezing
3. Shortness of breath
4. Chest tightness
Usually worsens with exercise
5. Inability to sleep
6. Nasal congestion
7. PEFR is 50 to 70% of personal best
Symptoms of Asthma attack

14. Symptoms of Asthma attack
Severe asthma attack
1. Severe wheezing
2. Severe difficulty breathing
3. Inability to speak in complete sentences
Sentences are interrupted by breathing
4. Inability to lie down
5. Signs of severe difficulty breathing
Rib retractions: ribs are visible during each breath
Nasal flaring: nostrils open wide during each breath

15. Symptoms of Asthma attack
Use of accessory muscles: neck muscles are prominent during
each breath
6. Chest pain
Sharp, chest pain when taking a breath, coughing
7. PEFR is <50% of personal best
8. Confusion
9. Rapid pulse
10. Fatigue
11. Rapid breathing rate

16. Symptoms of Asthma attack
Severe asthma attack
1. Severe wheezing
2. Severe difficulty breathing
3. Inability to speak in complete sentences
Sentences are interrupted by breathing
4. Inability to lie down
5. Signs of severe difficulty breathing
Rib retractions: ribs are visible during each breath
Nasal flaring: nostrils open wide during each breath
Use of accessory muscles: neck muscles are prominent during each
breath

17. Symptoms of Asthma attack
6. Chest pain
Sharp, chest pain when taking a breath, coughing
7. PEFR is <50% of personal best
8. Confusion
9. Rapid pulse
10. Fatigue
11. Rapid breathing rate

18. Establishing the Diagnosis
Not all that wheezes is asthma
•The Medical history
•Physical Examination
•Differential Diagnosis
•Laboratory Investigations

19. Physical Examination
•Hyperexpansion of the thorax
•Sounds of wheezing during normal breathing or a
prolonged phase of forced exhalation Increased nasal
secretions, mucosal swelling, sinusitis, rhinitis, or
nasal polyps
•Atopic dermatitis/eczema or other signs of allergic
skin problem

20. Investigations
Peak Expiratory Flow Rate
Spirometry
Chest Radiograph
SkinPrick Testing
Measurement of Airway Hyperresponsiveness
Sputum Examination

21. Peak Flow Testing
Peak Flow Meter
PEFR is used to assess the severity of wheezing in those who
have asthma. PEFR measures how quickly a person can exhale
air from the lungs
Peak expiratory flow rate (PEFR)

22. It measures how much air you can exhale.
FEV1(force expiratory volume) > 80% =
normal
Confirms the presence of airway
obstruction and measure the degree of lung
function impairment.
Monitor your response to asthma
medications
Spirometry (Lung function test)

23. If there are symptoms that may be caused by
another condition such as pneumonia, your
doctor may want to do a chest X-ray.
It also may help to clarify the
Problem if there is problem
with asthma treatment.
Chest X-Ray

24. A drop of liquid containing the allergen in placed on your
skin (generally forearms is used).
A small lance with a pinpoint is poked through the liquid
into the top layer of skin (prick test).
If you are allergic to the allergen, after about 2 minutes the
skin begins to form a reaction (red, slightly swollen, and
itchy: it makes a hive).
The size of the hive is measured and recorded.
The larger the hive, the more likely it is that you are allergic
to the allergen tested.
Allergy-skin Test

25. Allergy-skin test

26.  Prevents asthma symptoms from starting
 Taken daily by people with persistent asthma
 Brings down inflammation/treats constriction
Treatment: Controller Medications
Inhaled and oral
corticosteroids – not the
same as anabolic
steroids
Leukotriene modifier —
alternative to corticosteroids
Corticosteroid and long-acting
Bronchodilator (LABA)

27. Bronchodilators LABA

28. Reliever vs Controller Medications
Reliever Medicines
•Short acting
bronchodilators ( B2
agonists, Ipatropium)
Controller Medicines
•Inhaled steroids
•Leukotriene modifiers
•Long acting beta
agonists
•Theophyllines

29. Step 1 Treatment for Adults and Children >5 :
Mild Intermittent
Daily Long Term Control
Not needed
Quick Relief
Short-acting inhaled B2-agonist PRN
Increasing use, or use more than 2x/week, may
indicate need for long term control therapy
Intensity of treatment depends on severity of
exacerbation

30. Step 2 Treatment for Adults and Children >5 :
Mild Persistent
Daily Long Term Control
Anti-Inflammatory preferred
Inhaled corticosteroid (low dose) or
Cromolyn or Nedocromil
Or
Sustained release theophylline (to serum concentration 5-15
mcg/mL) is an alternative but not preferred
Leukotriene modifier may be considered

31. Step 2 Treatment for Adults and Children >5:
Mild Persistent (Cont)
Quick Relief
Short-acting inhaled B2 agonist PRN
Baily or increasing use indicates need
for increase long term control therapy
Intensity of treatment depends on
severity of exacerbation

32. Step 3 Treatment for Adults and Children >5:
Moderate Persistent
Daily Long-Term Control
Inhaled corticosteroid (medium dose)
OR
Inhaled corticosteroid ( low to medium dose)
AND
Long acting bronchodilator (long-acting B2-agonist or sustained
release theophylline)
IF NEEDED, increase to:
Inhaled corticosteroid (medium to high dose) and long acting
bronchodilator

33. Step 3 Treatment for Adults and Children >5:
Moderate Persistent (Cont)
Quick Relief
Short acting inhaled B2 agonist PRN
Daily or increasing use indicates increase
for long term control therapy
Intensity of treatment depends on severity
of exacerbation

34. Step 4 Treatment for Adults and Children >5:
Severe Persistent
Daily long term control
Inhaled corticosteroid (high dose)
AND
Long acting bronchodilator
Long –acting inhaled B2 agonists
OR
Sustained release theophylline
OR
Long acting B2 agonist tablets
AND
Oral corticosteroid, long term

35. Step 4 Treatment for Adults and Children >5:
Severe Persistent (Cont)
Quick Relief
Short acting inhaled B2 agonist PRN
Daily or increasing use indicates need for
increase long term control therapy
Intensity of treatment depends on severity of
exacerbation

36. Treatment of Exacerbation
High dose B2 agonist (inhales, sq,
IV)
Anticholinergics
Glucocorticoids- double inhaled
cdose or add systemic therapy

37. Bronchial thermoplasty
Invasive procedure for severe asthma
Is not painful (no nerves inside airways)
Risks : mainly lung collapse, bleeding and additional breathing
problems, mostly related to the bronchoscope.
Precaution: Pt. must be at least 18 y/o to have the procedure.
Pt. still need to use their asthma-maintenance medications after
the procedure
Benefits: Pt. may use rescue inhalers less often and are able to
engage strenuous physical activity than before
Surgical Treatment