Asthma, Medicine, Notes, Lecture

1. ASTHMA
Sarang Suresh Hotchandani
Final Year Bachelor in Dental Surgery (BDS) Student
@ Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, Pakistan

2. INTRODUCTION
• It is obstructive pulmonary disease.
• Defined as chronic inflammatory disorder of
airways characterized by airway hyper
responsiveness and airflow obstruction leading
to recurrent episodes of coughing, wheezing,
breathlessness & chest tightness…

3. ETIOLOGY
1) Airway Hyperactivity
• It is tendency of airway to narrow in response to
triggers that have little or no effect in normal
individuals.
• Causes of airway hyperactivity
• Airway inflammation
• Degree of airway narrowing
• Neurogenic mechanisms

4. ETIOLOGY cont’d
2) Atopy/Allergy
•Atopy is defined as ability to
rapidly produce IgG against
materials.

5. COMMON ALLERGENS
Indoor and outdoor allergy
Microbial exposure
Diet
Breast feeding
Vitamins
Pets
House dust
Fungi
Weather change
Drugs
 Aspirin & B-Blocker (Propranolol)
Exercise

6. PATHOPSIOLOGY
•Inhalation of an
allergen into airway
is followed by early
& late Broncho
constrictor
response.

7. EARLY OR IMMEDIATE BRONCHO
CONSTRICTOR RESPONSE
• Occurs shortly after exposure to allergen within
first 15 min - 1hour.
• Caused by mediators of immediate
hypersensitivity reaction; mast cells/basophils,
release mediators and causes inflammation that
leads to airway hyperactivity.

8. LATE BRONCHO CONSTRICTOR RESPONSE
• Occurs late after exposure to allergen about
4-6 hours after.
• Caused by influx of inflammatory cells and
then releasing mediators which causes
inflammation which leads to airway
hyperactivity.

9. NOTE...
NSAIDS
release
leukotrienes
which causes
asthma.
Exercise cause loss
of water from
respiratory mucosa
due to
hyperventilation
which triggers
mediator release.

10. Remodeling of airway
Fixed narrowing of airway
Fibrosis
COMPLICATIONS OF ASTHMA

11. CLINICAL FEATURES OF ASTHMA

12. • Daily,
Throughout
Day
• Asthma Attack
Daily
• Not Throughout
Day
• Greater Than 2
Days/Week
• Not Daily
• Asthma Attack
• Less Than 2
Days/Week
Intermittent
Mild
Persistent
Sever
Persistent
Moderate
Persistent

13. DIAGNOSIS OF ASTHMA

14. “
”
DIAGNOSIS IS
PREDOMINATELY
CLINICAL

15. • Clinical History
• Demonstration of airflow obstruction by using spirometry or peak flow
meter.
• If
• FEV ≥15% increases after administration of
bronchodilator, Asthma is present.
• > 20% diurnal variation on ≥ 3 days in week for
2 weeks on PEF, Asthma is present.
• FEV ≥ 15% decrease after 6 min exercise,
Asthma is present.

16. OTHER INVESTIGATIONS
• Measurement of allergic status
• Presence of atopy by skin prick test
• Measurement of Ig E
• FBC, for eosinophilia
• Radiological exam
• CXR often normal or show hyperinflation of lung.

17. MANAGEMENT
•STEP 1
•STEP 2
•STEP 3
•STEP 4
•STEP 5

18. STEP 1
•Occasional use of inhaled
short acting B2 – adrenal
receptor agonist
bronchodilators
• E.g. Salbutamol, Terbutaline (in mild intermittent asthma)

19. STEP 2
Anti
inflammatory
Therapy
Inhaled short
acting beta
agonist
Asthma
Control
Anti inflammatory = Inhaled corticosteroids; Budesonide, Fluticasone & Baclometason

20. STEP 3 (add on Therapy)
• Change short acting beta agonist with long acting beta
agonist(LABA).
Inhaled
Corticosteroids
Long Acting
Beta agonists

21. STEP 4 (Addition of 4th Drug)
• Used in those whose poor control on moderate dose of inhaled
corticosteroid & LABA.
• Discontinue the LABA from ICS and give any of following.

22. STEP 5
• continues use of oral steroids for control of symptoms
• Osteoporosis caused by corticosteroid can be prevented by
giving bisphosphonates.
• In atopic Patients, omalizumab (monoclonal antibody
directed against I g E.
• Note: once asthma is controlled slowly reduce dose of
corticosteroids.

23. EXACERBATION OF ASTHMA causes
•Viral and fungal infection
•Pollens
•Air pollution

24. Management of MILD to MODERATE Asthma
•Short course of rescue
oral corticosteroid
•(Prednisolone 30-60 mg
daily)

25. Management of STATUS ASTHAMATICUS
(Features)
•PEF = 33-50%
•Respiratory Rate ≥ 25
breaths/minute
•Heart rate ≥ 110 beats/minute
•Inability to complete sentence in
one breath

26. TREATMENT OF STATUS ASTHAMATICUS
• Oxygenation (O2 saturation should be > 92%)
• High dose inhaled bronchodilators
• SHORT ACTING B2 AGONIST ARE DRUG OF CHOICE
• Salbutamol
• Ipratropium bromide
• Systemic corticosteroids
• Orally; Prednisolone
• IV; Hydrocostisone
Still No
Response….
Go for
INTUBATION

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