The document summarizes a seminar on the management of bronchial asthma. It discusses the objectives of understanding the definition, pathophysiology, and approaches to managing asthma. It then presents two case scenarios of patients presenting with asthma exacerbations and outlines diagnostic and treatment approaches based on asthma control and severity. The key aspects of asthma management include assessment, pharmacological treatment using bronchodilators and inhaled corticosteroids, and stepping treatment up and down based on asthma control.
Running head RESPIRATORY CLINICAL CASE .docxtodd521
Running head: RESPIRATORY CLINICAL CASE 1
RESPIRATORY CLINICAL CASE 2
Respiratory Clinical Case
Ram Pandey
South University Online
Dr. Judith Cornelius
NSG 6001
Date: 04/08/2019
Patient Initials: CF Gender: Female Age: 65
Subjective Data
Chief Complaint
Patient comes to the clinic with the chief complaints of shortness of breath, wheezing and mild coughing.
HPI
For the last 2 months, patient has experienced asthma attacks on average more than 4 times a week, posttraumatic seizure 2 weeks after the accident and serious MVA 10 weeks ago. Anticonvulsant phenytoin started recently and there has not been any seizure activity since the initiation of therapy.
PMH
Patient has a history of periodic asthma attacks dating back to her early 20s. Three years ago, patient was diagnosed with mild congestive heart failure and placed on hydrochlorothiazide and sodium restrictive diet. Last year, CF placed on enalapril because of worsening CHF. Medication has controlled the symptoms relatively well the last year. Apart from enalapril, other medications prescribed for the patient include albuterol inhaler, theophylline SR capsules 300 mg PO BID, and PRN Phenytoin SR capsules 300 mg PO QHS. She has no known allergies. Patient has not had any surgeries.
Family History
The patient’s parents are both deceased. Her father succumbed to kidney failure at age 59 while her mother died of CHF aged 62
Social History
Patient attests that she is a nonsmoker and she does not consume alcohol. She takes four cups of diet colas and the same number of coffee cups
ROS
Positive for cough, wheezing, exercise intolerance and shortness of breath. Denies seizures, headaches and swelling of extremities
Gen
Pale, well-developed Caucasian female appearing to be anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Abdomen: non-tender, soft, non-distended no masses. Chest: Bilateral expiratory wheezes. Cardio: Regular rate and rhythm normal S1 and S2. Rectal: Guaiac negative. GU: Unremarkable. NEURO: A&O X3, cranial nerves intact. EXT: +1 ankle edema, on right, no bruising, normal pulses.
Objective Data
Vital Signs: BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”. After the albuterol treatment, vital signs are BP 134/79, HR 80, and RR 18
Physical Assessment and Diagnostic Testing: Na – 134, K - 4.9, Cl – 100 (all within normal limits), BUN – 21, Cr - 1.2, Glu – 110, Theophylline - 6.2, Phenytoin – 17, ALT – 24, AST – 27, Total Chol – 190 (substantially high, predicted moderate restriction). CBC – WNL, Chest Xray – Blunting of the left and right costophrenic angles, Peak Flow – 75/min (relatively low, normal should be between 80-100/min); after albuterol – 102/min, FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60% (predicted moderate obstruc.
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
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
Running head RESPIRATORY CLINICAL CASE .docxtodd521
Running head: RESPIRATORY CLINICAL CASE 1
RESPIRATORY CLINICAL CASE 2
Respiratory Clinical Case
Ram Pandey
South University Online
Dr. Judith Cornelius
NSG 6001
Date: 04/08/2019
Patient Initials: CF Gender: Female Age: 65
Subjective Data
Chief Complaint
Patient comes to the clinic with the chief complaints of shortness of breath, wheezing and mild coughing.
HPI
For the last 2 months, patient has experienced asthma attacks on average more than 4 times a week, posttraumatic seizure 2 weeks after the accident and serious MVA 10 weeks ago. Anticonvulsant phenytoin started recently and there has not been any seizure activity since the initiation of therapy.
PMH
Patient has a history of periodic asthma attacks dating back to her early 20s. Three years ago, patient was diagnosed with mild congestive heart failure and placed on hydrochlorothiazide and sodium restrictive diet. Last year, CF placed on enalapril because of worsening CHF. Medication has controlled the symptoms relatively well the last year. Apart from enalapril, other medications prescribed for the patient include albuterol inhaler, theophylline SR capsules 300 mg PO BID, and PRN Phenytoin SR capsules 300 mg PO QHS. She has no known allergies. Patient has not had any surgeries.
Family History
The patient’s parents are both deceased. Her father succumbed to kidney failure at age 59 while her mother died of CHF aged 62
Social History
Patient attests that she is a nonsmoker and she does not consume alcohol. She takes four cups of diet colas and the same number of coffee cups
ROS
Positive for cough, wheezing, exercise intolerance and shortness of breath. Denies seizures, headaches and swelling of extremities
Gen
Pale, well-developed Caucasian female appearing to be anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Abdomen: non-tender, soft, non-distended no masses. Chest: Bilateral expiratory wheezes. Cardio: Regular rate and rhythm normal S1 and S2. Rectal: Guaiac negative. GU: Unremarkable. NEURO: A&O X3, cranial nerves intact. EXT: +1 ankle edema, on right, no bruising, normal pulses.
Objective Data
Vital Signs: BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”. After the albuterol treatment, vital signs are BP 134/79, HR 80, and RR 18
Physical Assessment and Diagnostic Testing: Na – 134, K - 4.9, Cl – 100 (all within normal limits), BUN – 21, Cr - 1.2, Glu – 110, Theophylline - 6.2, Phenytoin – 17, ALT – 24, AST – 27, Total Chol – 190 (substantially high, predicted moderate restriction). CBC – WNL, Chest Xray – Blunting of the left and right costophrenic angles, Peak Flow – 75/min (relatively low, normal should be between 80-100/min); after albuterol – 102/min, FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60% (predicted moderate obstruc.
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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.
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.
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 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
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Bronchial Asthma slide share ppt
1. Seminar on;
Management of Bronchial Asthma
Prepared by Dr. Atinkut Abesha.
Moderator Dr. Girma (MD, Assistant professor of I. Medicine)
Date: 27/04/2014 E.C
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 1
2. Objectives
To know about definition of Asthma
To know about pathophysiology of Asthma
To know approaches to management of B. Asthma
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 2
3. Outlines
Introduction
Etiology and Risk factors of Asthma
Pathophysiology of Asthma
Classification of Asthma
Clinical presentations of Asthma
Diagnosis
Management of Asthma
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 3
4. Case scenario 1
Mr. X a 21 years old male patient presented with SOB, chest
tightness, and dry cough of 01 week duration which was
exacerbated during cold weather. Those symptoms came
1x/month. Associated to this he has hx of sneezing, rhinorrhea
and nasal congestion. He has also recurrent hx of itching
sensation around his nose. He has also family hx of Asthma,
DM and HTN from his father. He did not took any medication
before for those symptoms.
4
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
5. Case scenario 1… Cont
P/E: G/A: ASL
V/S: BP= 110/70, PR= 105, RR=28, T=36.9, SPO2= 91% with ATM
R/S: scattered wheezing on posterior chest bilaterally
N/S: COTPP
Investigation: CBC: WBC= 9.2, N=78%, E=8.1, Hgb=12.1, Hct=37.9,
MCV=84.2, PLT= 274
CXR=Unremarkable
Mgt: Salbutamol 6 PUFF PRN, prednisolone 40 mg/day for 01 week
5
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
6. Case scenario 1… Cont
1. What will be the possible Dx (Diagnostic flow chart)?
2. How do we assess the patient (Based on parameters)?
3. Where is her step of treatment
4. How do we manage the patient (Step up and Step down approach)?
5. Comment on the treatment which was given to the patient?
6
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
7. Case scenario 2
Ms. Y: a 28 years old known Asthmatic patient for the last 06
months duration who was on Budesonide: Formotelol
(Symbicort) which was taken 2 PUFF twice daily and
Salbutamol 6 PUFF PRN presented with exacerbation of SOB
of 02 day duration. Associated to this she has hx of whitish
productive cough, audible breath sound, chest tightness, LGIF
of the same duration. She also had hx of night time wake up
1x/wk . She has also previous hx of similar attack 02/month.
Othewise no hx of DM and HTN
7
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
8. Case scenario 2… Cont
P/E: G/A: ASL INO2
V/S: BP= 120/70, PR= 110, RR=30, T=36.8, SPO2= 96% with 4L &
82%ATM
R/S: diffuse wheezing on posterior chest bilaterally
N/S: COTPP
Investigation: CBC: WBC= 17.21, N=94%, E=1.6, Hgb=16.7, Hct=48.9,
MCV=92.3, PLT= 280
CXR= Hyper inflated lung
8
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
9. Case scenario 2… Cont
1. What will be the possible Dx (Diagnostic flow chart)?
2. How do we assess the patient (Based on parameters)?
3. Where is her step of treatment
4. How do we manage the patient (Step up and Step down approach)?
5. Comment on the treatment which was given to the patient?
9
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
10. Introduction… Def…
Asthma; a disease characterized by episodic airway
obstruction and airway hyperresponsiveness usually
accompanied by airway inflammation
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 10
11. Introduction… Epidemiology…
∼241 million people affected globally (Worldwide; 4.3%)
More prevalent among children (8.4%) than adults (7.7%)
Childhood M: F; 2:1, but Adulthood greater prevalence in
women
Mortality rate globally 0.19/100,000
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 11
12. Etiology and Risk factors of Bronchial Asthma
Allergen exposure
Occupational exposure
Air pollution
Infections
Tobacco
Obesity
Diet
Irritants
High intensity exercise in elite athletes
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 12
13. Pathophysiology of Bronchial Asthma
Histology of Bronchus;
Mucosa
Muscularis mucosae
Submucosa
Cartilaginous layer
Adventitia
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 13
16. Pathophysiology of Bronchial Asthma
Airway hyperresponsiveness is a hallmark of asthma;
Bronchoconstriction
airway inflammation, and
Mucous impaction
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 16
17. Classification of Bronchial Asthma
Intermittent
Persistent Based on Severity (symptoms)
Mild
Moderate
Sever
Childhood onset Asthma Based on age of Onset
Adult onset Asthma
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 17
18. Clinical Presentations of Bronchial Asthma
History of respiratory symptoms
Wheeze
Chest tightness Vary over time and
in intensity
Shortness of breath
Cough
Variable expiratory airflow limitation
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 18
19. Diagnosis of Bronchial Asthma
History
Physical Examination
Investigation
Pulmonary Function Tests
Eosinophil Counts
IgE
Skin Tests
Radioallergosorbent Tests
Exhaled Nitric Oxide
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 19
20. Diagnosis of B.Asthma…Investigation
Spirometry;
Assess how well the lungs work by measuring lung volume,
capacity, rates of flow, and gas exchange
Confirms Variable Expiratory Air flow limitations
FEV1, FEV1/FVC
Diurnal PEF variability
Lung function after treatment
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 20
21. Diagnosis of B.Asthma…Investigation
Spirometry;
Helps to differentiate Obstructive or Restrictive Lung diseases
Characteristics Obstructive Restrictive
FEV1 <80% of the predicted
normal
<80% of the predicted
normal
FVC but to a lesser extent
than FEV1
<80% of the predicted
normal
FEV1/FVC <0.7 >0.7
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 21
22. Diagnosis of B.Asthma…Investigation
Spirometry;
Clues b/n obstructive lung diseases
Characteristics Spirometry for Asthma Spirometry for COPD
FEV1 Increases by 12% after BD Doesn’t Increase by 12% after
BD
FVC May or May not be reduced Always Reduced
FEV1/FVC Less than 70% Less than 70 %
Serial Spirometry Vary or remain similar over time Deterioration in values in time
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
22
23. Diagnosis of B.Asthma…Investigation
Spirometry;
Once the diagnosis of asthma has been made, the main role
of lung function testing is for the assessment of future risk.
It should be recorded;
At diagnosis
3–6 months after starting treatment
Periodically thereafter.
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 23
24. Diagnosis of B.Asthma…Diagnostic flowchart
Patient with respiratory symptoms.
Are they typical of Asthma?
Detailed Hx & P/E for Asthma.
Are they supports Asthma Dx?
Is patient already taking asthma controller
treatment?
Perform Spirometry /PEF with reversibility test.
Is result support Asthma Dx?
Treat for Asthma
No Further Hx & Test for
alternative DX
Treat for
Alternative Dx
Y
e
s
No
- Arrange other tests
-Confirm Asthma Dx
Consider trial of
treatment for most
likely Dx or refer for
further investigations
yes
yes
No
N
o
No
Y
e
s
Yes
No
yes
Dx
step
es
for
Cont
rolle
r t/t
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 24
25. Diagnosis of B.Asthma…Diagnostic flowchart
Is patient already taking asthma controller treatment?
Variable
respiratory
symptoms and
variable airflow
limitation
Variable
respiratory
symptoms but no
variable airflow
limitation
Few respiratory
symptoms, normal
lung function and no
variable airflow
limitation
Persistent shortness
of breath and
persistent airflow
limitation
1 2 3
4
Diagnosis of
asthma is
confirmed
Assess the level
of asthma
control
Consider
repeating
Spirometry
1. If FEV1 is >70% predicted,
stepping down &reassess
after 2-4wks
2. If FEV1 is <70% predicted,
stepping up for 3 months
1. Symptom emerge
and lung function
falls: asthma is
confirmed…. Step Up
Consider stepping
down
2. ceasing
controller if no
change in
symptoms or lung
function (1 year
follow up)
Consider
stepping
up for 3
months
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
25
26. Assessment of Asthma
Asses Asthma control
Asses Asthma severity
Asses Comorbidity
Asses treatment issues
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 26
27. Assessment of Asthma
I. Assessment of Asthma control
Asthma control is assessed in two domains:
Symptom control (In the past 4 weeks)
Frequency of daytime asthma symptoms (>2/wk)
Any night waking due to asthma
For patients using SABA, frequency of SABA use (>2/wk)
Any Activity limitation due to Asthma
Well controlled, Partly controlled, Uncontrolled
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 27
28. Assessment of Asthma
I. Assessment of Asthma control
Risk of adverse outcomes (Exacerbations)
≥1 exacerbation in the previous year
Socioeconomic problems
Poor adherence
High SABA use
Incorrect inhaler technique
Low Lung function test
Exposure
Type II inflammatory mediators like blood eosinophilia
Other medical conditions
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 28
29. Assessment of Asthma
II. Asthma severity
Mild
Moderate
Sever
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 29
30. Assessment of Asthma
III. Comorbidities
Contribute to symptoms and poor quality of life, and
sometimes to poor asthma control
Rhinitis
Rhinosinusitis
GERD
Obesity
OSA
Depression
Anxiety Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 30
31. Assessment of Asthma
IV. Treatment issues
Inhaler technique
Written asthma action plan
Patient’s attitudes and goals for their asthma and medications
Document the patient’s current treatment step
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 31
32. Management of Bronchial Asthma
Goals of management
To achieve good symptom control
To minimize future risk of asthma-related mortality
To minimize exacerbations
To minimize persistent airflow limitation
To minimize side-effects of treatment
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 32
33. Management of Bronchial Asthma
In order to achieve the above goals;
Non pharmacological treatment
Pharmacological treatment
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 33
34. Management of Bronchial Asthma
I. Non pharmacological treatment
Reducing triggers
Treating modifiable risk factors
Vaccination
Bronchial thermoplasty
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 34
35. Management of Bronchial Asthma
II. Pharmacological treatment
Bronchodilators (β2 -agonists, anticholinergics, and theophylline)
Controllers (Anti-Inflammatory/Antimediator); Costicosteroids
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
35
36. Management of Bronchial Asthma
II. Pharmacological treatment
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 36
37. Management of Bronchial Asthma
For adults and adolescents step Up/Down approach
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 37
38. Management of Bronchial Asthma
Patients should be seen 1–3 months after starting treatment
Every 3–12 months thereafter.
After an exacerbation, a review visit within 1 week should be
scheduled
Stepping down treatment when;
Asthma is well controlled for 2–3 months and
Lung function has reached a plateau
N.B. Complete cessation of ICS is associated with a significantly
increased risk of exacerbations
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 38
39. Management of Bronchial Asthma
It involves a continual cycle that involves assessment,
treatment and review by appropriately trained personnel
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 39
40. References
Harrison’s principles of Internal Medicine 21st edition
GINA, 2022 updated
Up to date 2018
Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern) 40
41. Management of Bronchial Asthma; BY: Atinkut A. (Medical Intern)
Thanks A Lot!!!
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Editor's Notes
in those with a predisposition to atopy
Mucosa, lining the inside of the bronchus.
Muscularis mucosae, a smooth muscle layer under the mucosa.
Submucosa, a connective tissue layer with seromucous glands.
Cartilaginous layer, a layer of cartilage plates located beneath the submucosa.
adventitia, the deepest layer separating the bronchus from surrounding tissues
Most commonly, this
inflammation is eosinophilic in nature. In some patients, neutrophilic
inflammation may be predominant, especially in those with more
severe asthma. Mast cells are also more frequent. Many
inflammatory cells are present in an activated state, as will be
discussed in the section on inflammation.
. It is defined as an acute narrowing response of the airways in reaction to agents that do not elicit airway responses in nonaffected individuals or an excess narrowing response to inhaled agents as compared to that which would occur in nonaffected individuals
An estimated 5–20% of new cases of adult-onset asthma can be attributed to occupational exposure
Mild persistent: symptoms of asthma occur no more than two days per week or two times per month.
Moderate persistent: Increasingly severe symptoms of asthma occur daily and at least one night each week
Sever persistent :symptoms occur several times per day almost every day
more than one-third of patients with a physician diagnosis of asthma do not meet the criteria for the diagnosis.
Physical Examination In between acute attacks, physical findings may be normal. Many patients will have evidence of allergic rhinitis with pale nasal mucus membranes. Five percent or more of patients may have nasal polyps, with increased frequency in those with more severe asthma and aspirin-exacerbated respiratory disease. Some patients will have wheezing on expiration (less so on inspiration). During an acute asthma attack, patients present with tachypnea and tachycardia, and use of accessory muscles can be observed. Wheezing, with a prolonged expiratory phase, is common during attacks, but as the severity of airway obstruction progresses, the chest may become “silent” with loss of breath sounds.
Spirometry Reading
Sometimes abnormal but may be normal in allergic induced asthma
Always abnormal
Consider repeating spirometry after withholding BD (4 hrs for SABA, 24 hrs for twice-daily ICSLABA, 36hrs for once-daily ICS-LABA) or during symptoms. Check between-visit variability of FEV1, and bronchodilator responsiveness. If still normal, consider other diagnoses (Box 1-5, p.27). If FEV1 is >70% predicted: consider stepping down controller treatment (see Box 1-5) and reassess in 2–4 weeks, then consider bronchial provocation test or repeating BD responsiveness. If FEV1 is