For Under Graduates

1. Bronchial Asthma
Management
Dr Deepak Kumar

2. Definition
• Chronic airway inflammation
• Hyper-responsive airway with reversibility
• Atopic and Non atopic type
• Exercise induced
• NSAIDs induced
• Cough variant type

3. Triggers
• Infections
• Exercise
• Seasonal
• Emotions
• Food
• Hormonal

4. Pathogenesis

8. Signs and Symptoms

9. Common presenting symptoms
• Cough
• Fast Breathing
• Dyspnea/PND/Orthopnea
• Chest pain
• Cyanosis
• Irritability, Lethargy/Drowsy, Altered
Sensorium, Seizures- Hypoxia.

10. Signs
• Tachycardia
• Tachypnea
• Spo2
• Gen Appearance- sensorium, posture
• Cyanosis, Clubbing, LDN

11. Signs of atopy
• Skin Rashes- eczema
• Dennie’s line- B/L lower eyelids skinfold
• Allergic Salute- Bony nasal septum end
• Allergic Shiners
• Conjuctivitis/ phlyctenular type in – TB
• Mouth breathing – keeps mouth open.

13. CHEST Examination
• Hyperinflated Chest
• Hyper-resonant on percussion
• Rhonchi
• Wheeze
• Crackles
• ? Absent Air Entry.

14. Key indicators for considering
diagnosis of asthma
• Typical history
• Intermittent symptoms (reversible)
• Association of symptoms to weather changes,
dust, smoke, exercise, viral infection, animals ,
mites, mold, pollen, strong emotional expression
, airborne chemicals or dust
• Diurnal variation
• Family history
• Presence of atopy, allergic rhinitis, skin allergies

15. Investigations

16. • Blood Investigations.
• Radiological Investigations
• Rule out other etiology
• Specific- Spirometry and Allergy tests.

17. Spirometry

19. Spirometry Curves

20. PARAMETERS OBSTRUCTIVE RESTRICTIVE
FEV1 Low Low
FVC Normal to High Low
FEV1/FVC

21. Management
No Cure, but can be controlled well

22. Long Term Strategy
• Identify and Eliminate Exacerbating Factors
• Pharmacological Therapy
• Education of parents and patients

23. Pharmacotherapy
• Bronchodilators
• Steroids
• Mast cells Modifier
• LKT modifiers

24. Pharmacological management
• Assessment of symptom control
• Assessment of risk of exacerbation
• Selection of medication
• Selection of route/appropriate device
• Monitoring

25. Assessment of symptoms
• Daytime symptoms – weekly
• Night Symptoms- monthly
• Use of LABA
• Physical limitations
• Acute Exacerbations

29. Selection of device

35. Selection of device
• < 4 year- MDI + Spacer + Face Mask.
• > 4 year- MDI + Spacer.
• > 12 years – Direct MDI.

36. Nebulizers

40. Monitoring
• Follow-up
• Check technique and compliance
• Symptom diary
• Assess – controlled, partial and poor control

42. Acute Exacerbation

43. Acute Exacerbation
(Status Asthmaticus)
• Increase in Symptoms
• Severity- mild/mod/Sev
Parameter Mild Moderate Severe
Sensorium N Anxious Agitated
Dyspnea Absent Mod Sev
Speech Sentences Phrases Difficulty
Accessory muscles min Chest Nasal
Pulsus Paradoxus < 10 10-20 >20
PEFR >80 60-80 <60
Spo2 >95 90-95 <90

49. Attendance !!!