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Bronchial Asthma
Definition
Epidemiology
Risk factors
Pathology &
pathogenesis
Diagnosis
Management
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Definition
A chronic inflammatory disorder of
the airways associated with airway
hyperresponsiveness that leads to
recurrent episodes of wheezing,
breathlessness, chest tightness, and
coughing. These episodes are
usually associated with reversible
airway obstruction.
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Epidemiology
Asthma is a problem worldwide, with an
estimated 300 million affected individuals
Prevalence increasing in many countries,
especially in children
A cause of a significant number of
preventable deaths
A major cause of school/work absence
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Mechanisms: Asthma
Inflammation
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Diagnosis
History and physical examination
Pulmonary function tests
Other laboratory tests
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3
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Time (sec)
Note: Each FEV1 curve represents the highest of three repeat measurements
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Measuring Airway
Responsiveness
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Laboratory Tests
Chest X-ray
Blood tests
Eosinophil count
IgE level
Skin tests
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Management of Asthma
Education and develop patient/doctor
partnership
Identify and reduce exposure to risk
factors
Pharmacotherapy of asthma
Assess, treat, and monitor asthma
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Pharmacotherapy of Asthma
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Controllers
Inhaled glucocorticoid
Long-acting inhaled 2-agonists
Leukotriene modifiers
Theophylline
Cromones
Anti-IgE
Systemic glucocorticoids
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Low
Medium High
> 1000
>500
Budesonide-DPI
200-600 600-1000
>1000
Fluticasone
100-250 250-500
>500
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Relievers
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Treatment Goals
Achieve and maintain control of symptoms
Maintain normal activity levels, including
exercise
Maintain pulmonary function as close to
normal as possible
Prevent asthma exacerbations
Avoid adverse effects from asthma
medications
Prevent asthma mortality
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Symptoms Night
symptoms
PFT
Mild
intermittent
< 2/week
< 2/month
PEF / FEV1
N
PEF var. < 20%
Mild
persistent
> 2/week
not daily
> 2/ month
PEF / FEV1 N
PEF var. 20-30%
Moderate
persistent
Daily
symptoms
> 1/week
PEF/FEV1 60-80%
PEF var. > 30%
Severe
persistent
Cont.
symptoms
Frequent
Controlled
(All of the following)
None (2 or less /
week)
Partly controlled
(Any present in any
week)
More than
twice / week
None
Any
Nocturnal symptoms /
None
awakening
Any
None (2 or less /
week)
Lung function
(PEF or FEV1)
Exacerbation
Normal
None
Uncontrolled
More than
twice / week
3 or more
features of
partly
controlled
asthma present
in any week
1 in any week
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REDUCE
LEVEL OF CONTROL
TREATMENT OF ACTION
maintain and find lowest
controlling step
partly controlled
consider stepping up to
gain control
INCREASE
controlled
uncontrolled
exacerbation
REDUCE
INCREASE
TREATMENT STEPS
STEP
STEP
STEP
STEP
STEP
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Management of Acute
Exacerbations
PEF
50-75%
Uncontrolled asthma
Oxygen saturation
Nebulized -2
agonist
Check PEF
>75%
Home
50-75% Home with
short course of
prednisolone
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Management of Acute
Exacerbations
PEF
< 50%
Acute severe asthma
Oxygen
Nebulized -2 agonist
Nebulized
ipratropium
Check PEF
> 50%
Home
< 50%
Admit
Systemic steroids
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Management of Acute
Exacerbations
PEF
< 33%
Life threatening
asthma
Admit to ICU
Oxygen
Nebulized -2
agonist and
ipratropium
Systemic steroids
Consider assisted
ventilation
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