Asthma is a chronic inflammatory disorder of

the airway which manifest by symptoms such

as episodic breath-lessness, wheezing, chest
tightness and cough particularly at night and
the early morning.
Inflamation makes the airways sensitive to
stimuli such as allergens, chemical irritans,
tobacco smoke, cold air, or exercise.

Bronchial asthma is one of the most common

chronic disease.
Not all asthmatic patients suffer from
chronic symptoms recuiri continuous
administration of anti asthmatic drugs.
Chronic asthma is the asthma for which we
should give continuous and cautions treatment
in daily clinical practice.
Chronic asthma is characterized by :
1.Clinically, recurrent episodes of dyspnea and
wheezing caused by reversible airway
narrowing
2.Physiologically, increased airway
responsiveness
3.Pathologically, by inflammation of the airway
Eo infiltration and damage to the airway
epihelium
4.Immunologically, increased IgE production
Ask patient : Does the patient have

-Reccurents attacks of wheezing

-Cough or wheeze at night ?
-Cough or wheeze after excersice
-Cough, wheeze or chest tightness of exposure
to allergans or pollutants?
Classive severity of asthma

STEP 1 : INTERMITTENT
2 : MILD PERSISTENT
3 : MODERATE PERSISTENT
4 : SEVERE PERSISTENT
SABA
Anti Cholinergics
Short acting THEOPHYLLIN
Adrenalin injection
Corticosteroid
Sodium cromoglycate
Nedocromil
Laba
Sustained released theophylline
Ketotifen
Daily medication :
- Either inhaled corticosteroid, 200-500 mcg,
cromoglycate, nedocromil, or sustained-
release theophylline
- If needed, increase inhaled corticosteroid. If
inhaled corticosteroids currently equal 500
mcg, or add long-acting bronchodilator
(especially for nighttime symptoms) : either
long-acting inhaled 2-agonist, sustained-
release theophylline, or long-acting 2-agonist
tablets or syrup
- Review of symptoms
- Measurement of lung function as much as
possible

Long-term peak flow monitoring for patients

with persistent asthma is important for
providing objective measurement of the course
of the disease.
The aim of treatment of control of asthma
Out come control of asthma :
- Minimal chronic symptoms
- Minimal episodes
- No emergency visits
- Minimal need for 2 agonist
- No limitation on activities

- PEF variability < 20%

- (Near) normal PEF
- Minimal (or no) adverse effects from medicine
The best way to stop asthma attacks is prevention :
Identify and avoid triggers eg. :
- Domestic dust mites
- Animal allergens
- Tobacco smoke
- Cackroach
- Mold
- Smoke
- Cold
- Physical activity