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ADULT
Zulkarnain Arsyad
Pulmonary Sub. Division of Internal
Medicine Medical Faculty Andalas
University M.Djamil Hospital Padang
What is Asthma?
Chronic inflammatory disorder of airways
Inflammation causes airway hyper responsiveness often associated with
symptoms (wheeze, cough, SOB).
Obstruction is reversible
Introduction
In the community prevalence of bronchial asthma
approximately are 4 6 %
Prevalence of asthma appears to be increasing in
the children than adult
In the population, male asthmatic patients
approximately are same with the female asthmatic
patients
The are various factors, such as the environment,
socio economic status, climate and ethnic group
have the role in the prevalent of asthma
Pathogenesis
:
Airway
Hyperresponsiveness
Genetic*
INDUCERS
Allergens,Chemical sensitisers,
Air pollutants, Virus infections
INFLAMMATION
Airflow Limitation
TRIGGERS
Allergens, Exercise,
Cold Air, SO2 Particulates
SYMPTOMS
Cough Wheeze
Dyspnoea
Eosinophils in Asthma
Pathogenesis:
Pathophysiology of asthma
Variety of stimuly
chronic a.w inflamation/ HBR
Acute reversible a.w obst
Inflamatory component
early respont
late respont
Patophysiology of asthma
Airway inflamation
Pathophysiology of Asthma
If left untreated chronic airway inflammation may
lead to permanent airway changes
Airway thickening causes irreversible airflow limitation
and shortened life expectancy
URI
Allergens
Aerobic Exercise
Irritants
Air Pollution
Strong emotions
Medications
Beta blockers
Clinical Presentation
Wheezing
Dyspnea
Chest tightness
Use of accessory respiratory muscle
Central or peripheral cyanosis
Tachycardia
Prolonged expiration
Altered mental status
Classification of Severity
CLASSIFY SEVERITY
Continuous
Limited physical
activity
Daily
Attacks affect activity
> 1 time a week
but < 1 time a day
Nocturnal
Symptoms
Frequent
FEV1 or PEF
60% predicted
Variability > 30%
60 - 80% predicted
Variability > 30%
80% predicted
Variability 20 - 30%
Asymptomatic
and normal PEF
between attacks
2 times a month
80% predicted
Variability < 20%
The presence of one feature of severity is sufficient to place patient in that category.
GOALS OF TREATMENT
THERAPY
QUICK-RELIEF MEDICATIONS (RELIEVER)
LONG-TERM CONTROL MEDICATIONS
(CONTROLLER)
Reliever
Medications
Rapid-acting inhaled 2-agonist
for symptoms (but < 3-4times/day)
Rapid-acting inhaled 2-agonist,
cromone, or leukotriene modifier
before exercise or exposure to
allergen
Reliever
Medications
Inhaled glucocorticosteroid
(< 500 g BDP or equivalent)
Other options:
inhaled anticholinergic, or
short-acting oral 2-agonist, or
short-acting theophylline
Inhaled glucocorticosteroid
plus leukotriene modifier
Reliever
Medications
Rapid-acting inhaled
2-agonist for symptoms
(but < 3 - 4 times/day)
Other options:
inhaled anticholinergic or
short-acting oral
2-agonist or
short-acting theophylline
Reliever
Medications
Rapid-acting inhaled
2-agonist for symptoms
(but < 3-4 times/day)
Other options:
inhaled anticholinergic or
short-acting oral
2-agonist or
short-acting theophylline
Controller:
Controller:
Controller:
None
Controller:
Daily inhaled
corticosteroid
Daily inhaled
corticosteroid
Daily longacting inhaled
2-agonist
Daily inhaled
corticosteroid
Daily long
acting inhaled
2-agonist
plus (if needed)
-Theophylline-SR
-Leukotriene
-Long-acting inhaled
2- agonist
-Oral corticosteroid
When
asthma is
controlled,
reduce
therapy
Monitor
STEP 2:
Mild Persistent
STEP 3:
Moderate
Persistent
STEP 4:
Severe
Persistent
STEP Down
Principles of treatment
Use quick-relief rescue medication for all
pt
Persistent asthma requires :
Long-term-control medication
anti-inflammatory meds preferred
Step up treatment if control not maintained
Step down if in control
Management of
Asthma Exacerbations:
Key Points
Management of
Asthma Exacerbations:
Key Points (continued)
or
Decreased
responsiveness to inhaled
beta2-agonists, or
Decreased
Management of
Asthma Exacerbations
Management of
Asthma Exacerbations (continued)