ASTHMA

DEFINITION OF ASTHMA
Is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. Airway obstruction that is reversible either spontaneously or with treatment

PATHOPHYSIOLOGY
Allergens/acute substances, stress and exercises Bronchial tree tightening
Lining of air passages swells Reduce airflows

Sign and symptoms

Dyspnea common symptoms of Cough asthma Wheezing (high-pitched whistling sounds when breathing out) Chest tightness Difficulty moving air in and out of the lungs Use of accessory muscles Nasal flarring

Emergency symptoms:
a. Pallor b. Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack c. Extreme difficulty breathing d. Tachycardia e. Severe anxiety due to shortness of breath f. Sweating

CLASSIFICATION OF ASTHMA
Classification step 1 Severity Mild intermittent Frequency of Symptoms Without Treatment Symptoms occur two days or less each week and two nights or less each month Symptoms occur up to five days each week and up to five nights in a month Symptoms occur at least once during every day and several nights a week Symptoms occur throughout the day, every day, and most nights

step 2

Mild persistent

step 3

Moderate persistent

step 4

Severe persistent

COMPLICATIONS OF ASTHMA
1. STATUS ASTMATICUS: is a life-threatening complication of asthma. It is a condition where an individual going through an asthma attack does not respond to any of the usual asthma treatments. In this situation, there is no improvement in asthma symptoms such as chest tightness and difficulty breathing. This asthma complication may lead to death. PNEUMOTHORAX: is a condition where air leaks out of the lungs. In asthma the rupture of overstretched alveoli or air sacs in the lungs

2.

Cont.. COMPLICATIONS OF ASTHMA

3. SEVERE COUGHING: EFFECTS: Coughing is one of the manifestations of asthma. When an asthmatic patient experiences a severe coughing episode, the following complications may occur: a fractured rib, urinary incontinence in women and fecal incontinence in men or women. 4. Corticosteroid Side Effects: Chronic sufferers of asthma may experience the following due to long-term use of this class of drugs: a. easy skin bruising b. Osteoporosis c. facial changes d. skin dystrophy

Common asthma triggers include:

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Animals (pet hair or dander) Dust Changes in weather (most often cold weather) Chemicals in the air or in food Exercise Mold Pollen Respiratory infections, such as the common cold Strong emotions (stress) Tobacco smoke

RISK FACTORS
1. Living in cities, where the concentration of particulate pollutants in the air is high 2. Family history of asthma 3. Recurrent upper respiratory INFECTION as a child 4. Cigarette smoking or exposure to ENVIRONMENTAL CIGARETTE SMOKE 5. Long-term or repeated exposure to chemicals such as cleaning solutions, paints, industrial chemicals used in manufacturing, pesticides and herbicides, and aerosols 6. Presence of ALLERGIC RHINITIS, atopic DERMATITIS, or chronic SINUSITIS

Laboratory Findings:
Increased WBC count with eosinophilia Viscid sputum on gross examination Curschmanns spirals on microscopic examination of sputum Charcot-Leyden crystals Obstructive pattern on the pulmonary function tests Diminished peak expiratory flow rate (normal: 450-650 L/min in men; 350-500 L/min in women) Respiratory alkalosis and mild hypoxemia in ABGs.

Curschmanns spirals

Charcot-Leyden crystals

Asthma: Treatment
Severe ambulatory asthma:
Daily maintenance therapy with inhaled corticosteroids Daily oral sustained-release theophylline or oral 2agonist drugs Long-acting inhaled 2-agonist drug (salmeterol) Inhaled anti-cholinergic drug (ipratropium bromide) Short-acting inhaled 2-agonist drug for breakthrough wheezing Oral steroids

Asthma: Treatment
Status asthmaticus:
Supplemental oxygen, 1-3 L/min Monitoring with oximetry Inhaled 2-agonist agents Intravenous aminophylline Subcutaneous terbutaline Intravenous corticosteroids Inhaled corticosteroids Oral corticosteroids Supportive: hydration, physical therapy, MV

Asthma: Prognosis
Outlook is excellent because of the availability of medications. Better prognosis in those who develop asthma early in life.

Beta2-agonists
In hospitalised patients nebulised beta2-agonist is required frequently and a dose of 0.15 mg/kg (maximum 5 mg/dose) can be given every 20 minutes and then at longer intervals as the patient improves. If beta2-agonist is required frequently it should be administered together with systemic steroids and preferably oxygen at 6-8 l/min. Beta2-agonists may also be delivered via continuous nebulisation or via the parenteral route in the more severe cases in which close monitoring is necessary.

Oxygen
In moderate or severe acute asthma hypoxaemia is often present. Supplementary oxygen by face mask or headbox is mandatory to correct hypoxaemia and relieve dyspnoea.

Systemic corticosteroids
If the attack is severe or if there is a poor response to initial treatment with nebulised beta2-agonist therapy a short course of a systemic corticosteroid should be administered.

Ipratropium bromide
has been shown to give additional bronchodilatation when added to nebulised beta2-agonists. Addition of ipratropium bromide may be considered when response to therapy with a combination of corticosteroids, frequent beta2-agonists and oxygen is inadequate. AMINOPHYLLINE Oral theophylline is not indicated in the management of acute asthma.