Professional Documents
Culture Documents
MANAGEMENT
Magnitude of the Problem
INFLAMMATION
Airway
Hyperresponsiveness Airflow Limitation
Symptoms- (shortness
Risk Factors of breath, cough,
(for exacerbations) wheeze)
Cockroaches
Water intake accomplished by dribbling salt solution from under armpits to the mouth. If air is
too dry salt crystallizes and process stops
Asthma: Pathological changes
Risk Factors that Lead to Asthma Development
Predisposing Factors
Atopy Contributing Factors
Respiratory infections
Small size at birth
Causal Factors
Indoor Allergens Diet
– Domestic mites Air pollution
– Animal Allergens – Outdoor pollutants
– Cockroach Allergens – Indoor pollutants
– Fungi Smoking
Outdoor Allergens – Passive Smoking
– Pollens – Active Smoking
– Fungi
Occupational Sensitizers
DIAGNOSIS OF ASTHMA
Physical examination
Wheeze -
Usually heard without a stethoscope
Dyspnoea -
Rhonchi heard with a stethoscope
Use of accessory muscles
Remember -
Absence of symptoms at the time of examination
does not exclude the diagnosis of asthma
Diagnostic testing
CLASSIFY SEVERITY
Clinical Features Before Treatment
Nighttime
Symptoms PEF
Symptoms
STEP 4 Continuous
<60% predicted
Severe Limited physical Frequent
Variability >30%
Persistent activity
STEP 3 Daily >60%-<80%
Moderate Use b2-agonist daily >1 time week predicted
Persistent Attacks affect activity Variability >30%
STEP 2
>1 time a week but >80% predicted
Mild >2 times a month
<1 time a day Variability 20-30%
Persistent
The presence of one of the features of severity is sufficient to place a patient in that category.
Global Initiative for Asthma (GINA) WHO/NHLBI, 2002
Goals to Be Achieved in Asthma
Control
Achieve and maintain control of symptoms
Prevent asthma episodes or attacks
Minimal use of reliever medication
No emergency visits to doctors or hospitals
Maintain normal activity levels, including exercise
Maintain pulmonary function as close to normal
as possible
Minimal (or no) adverse effects from medicine
Tool Kit for Achieving Management
Goals
Relievers
Preventers
Patient education
What Are Relievers?
- Rescue medications
- Quick relief of symptoms
- Used during acute attacks
- Action lasts 4-6 hrs
RELIEVERS
Xanthines
Theophylline
Adrenaline injections
What are Preventers?
Corticosteroids Anti-leukotrienes
Prednisolone, Betamethasone Montelukast, Zafirlukast
Beclomethasone, Budesonide
Fluticasone Xanthines
Theophylline SR
COMBINATIONS
Salmeterol/Fluticasone
Formoterol/Budesonide
Salbutamol/Beclomethasone
Reliever
SALBUTAMOL INHALER
100 mcg:
1 or 2 puffs as necessary
LEVOSALBUTAMOL INHALER
50 mcg :
1 or 2 puffs as necessary
Preventer
Anti-inflammatory