The document discusses asthma as an inflammatory airway disease characterized by symptoms such as wheezing and shortness of breath, with diagnosis based on clinical history and symptoms. Chronic obstructive pulmonary disease (COPD) is described as a progressive condition with airflow limitation that is generally irreversible, classified by severity based on spirometry and symptoms. Both conditions involve acute exacerbations and significant management strategies, including medication and assessment of severity.

1. Asthma/copd

2. Asthma
• Asthma is an inflammatory disease of
the airways triggered by external
stimuli in genetically-predisposed
individuals.
• This leads to mucus secretion,
bronchoconstriction and airway
narrowing.

3. Diagnosis
There is no gold standard diagnostic clinical test in diagnosing asthma.
Asthma diagnosis is based on a combination of:
• History
○ wheeze
○ cough
○ chest tightness
○ shortness of breath
• Presence of obstructive airflow reversibility

6. Acute exacerbation of asthma
•Acute exacerbation of asthma is defined as progressive or sudden
•onset of worsening symptoms such as shortness of breath, chest
•tightness, wheezing and coughing
• Assessment
• History
• Clinical Examination
• Peak Flow Measurement (PEFR)
• Arterial Blood Gases - in patients who have any of the severe or life threatening features
• CXR if a pneumothorax, pneumonia or lung collapse is suspected

7. • Features of severe asthma:
 Unable to complete a sentence in one breath
 Respiratory rate >25/min
 Pulse rate>120/min
 A PEFR <50% of best achievable or predicted value (refer to nomogram) or a single reading of <200 L/min
• Features of life-threatening asthma:
 Silent chest, cyanosis, feeble respiratory effort
 Bradycardia, Hypotension
 Exhaustion, confusion or coma
 PEFR usually <33% of predicted or best achievable value (or a single reading of <100 L/min or patients who are
not able to blow)
 ABG markers of very severe, life-threatening attacks include:
• a normal (5-6 kPa or 36-45 mmHg) or high P,C02
• severe hypoxaemia (P,02 <8 kPa or 60 mmHg) despite oxygen therapy
• a low pH

11. CRITERIA FOR ADMISSION/DISCHARGE
• All patients with severe, life-threatening asthma and those with PEF <75%
personal best or predicted one hour after initial treatment should be admitted.
• persistent symptoms
• previous near-fatal asthma attack
• living alone/socially isolated
• psychological problems
• physical disability or learning difficulties
• asthma attack despite recent adequate steroid treatment
• pregnancy
• All patients with severe, life-threatening asthma and those with PEF 75%
personal best or predicted one hour after initial treatment can be discharged.

13. CHRONIC OBSTRUCTIVE PULMONARY
DISEASE (COPD)

14. INTRODUCTION
• GOLD Definition:
• COPD is a disease state characterized by airflow limitation that is not
fully reversible. The airflow limitation is usually both progressive and
associated with an abnormal inflammatory response of the lungs to
noxious particles or gases and associated with systemic
manifestations.

15. GOLD Classification of COPD

16. CLASSIFICATION OF COPD SEVERITY BASED ON SPIROMETRY IMPAIRMENT AND SYMPTOMS
COPD Stage Severity Classification by post bronchodilator spirometry values Classification by
symptoms and disability
I Mild FEV1/FVC <0.70
FEV1 > 80% predicted
Shortness of breath when
hurrying on the level or
walking up a slight hill
(MMRC 1)
II Moderate FEV1/FVC < 0.70
50% < FEV1 < 80% predicted
Walks slower than
people of the same age
on the level because of
breathlessness; or stops
for breath after walking
about 100 m or after a
few minutes at own pace
on the level (MMRC 2 to 3)
III Severe FEV1/FVC < 0.70
30% < FEV1 < 50% predicted
Too breathless to leave the
house or breathless when
dressing or undressing
(MMRC 4)
IV Very severe FEV1/FVC < 0.70
FEV1 < 30% predicted or
FEV1 < 50% predicted plus
chronic respiratory failure
Presence of chronic
respiratory failure or
clinical signs of
right heart failure

17. RISK FACTORS
• Tobacco smoking
• Exposure to indoor/outdoor pollution (E.g: dust, vehicle fumes).
• Exposure to allergens, occupational irritants.
• Genetic predisposition (E.g: Alpha-1 antitrypsin deficiency).
• Family history of COPD.
• Poor socioeconomic status
• History of recurrent childhood infections.

18. ACUTE EXACERBATIONS OF COPD
• Acute worsening of respiratory symptoms associated with increased airway inflammation,
increased mucus production and marked gas trapping.
• Associated with increased mortality rate, accelerated decline in lung function and impaired quality
of life.
• 3 cardinal symptoms of exacerbation:
- Increased shortness of breath
- Increased cough
- Increased sputum volume/purulence
Other symptoms during exacerbation:
- Upper respiratory tract infection symptoms (E.g Runny nose, sore throat).
- Increased wheezing
- Chest tightness
- Reduced effort tolerance
- Increased fatigue

19. Management of Severe but Not Life-threatening Exacerbations of
COPD in the Emergency Department or the Hospital - Summary of
treatment (Adapted from GOLD 2007)
 Assess severity of symptoms, blood gases, chest X-ray
 Administer controlled oxygen therapy and repeat arterial blood gas
measurement after 30-60 mins
 Bronchodilators: Increase doses and/or frequency
 Combine B-agonists and anticholinergics - Use spacers or air-driven
nebulizers
 Consider adding intravenous methylxanthines (aminophylline), if needed
 Add oral or IV corticosteroids
 Consider antibiotics (oral or occasionally IV) in the presence of signs of
bacterial infection
 Consider non-invasive mechanical ventilation

20. COMPLICATIONS
• Respiratory failure (either type 1 or type 2)
• Cor pulmonale (Right ventricular failure secondary to chronic hypoxia)
• Acute exacerbations (infective or non-infective)
• Secondary polycythaemia