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Bronchial Asthma Definition Patho-physiology Diagnosis Management

Bronchial Asthma Definition Patho-physiology Diagnosis Management. Asthma prevalence in Saudi Arabia. Children and Adolescents: 20 % Adults : 10 %. Pathology of Asthma. Inflammation. Airway Hyper-responsiveness. Airway Obstruction. Symptoms of Asthma.

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Bronchial Asthma Definition Patho-physiology Diagnosis Management

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  1. Bronchial Asthma • Definition • Patho-physiology • Diagnosis • Management

  2. Asthma prevalence in Saudi Arabia • Children and Adolescents: 20 % • Adults : 10 %

  3. Pathology of Asthma Inflammation Airway Hyper-responsiveness Airway Obstruction Symptoms of Asthma

  4. Source: Peter J. Barnes, MD Mechanisms: Asthma Inflammation

  5. During an asthma attack…

  6. Asthma Microscopic Pathology Obstructed Inflammed Bronchi

  7. Bronchoconstriction Before 10 Minutes After Allergen Challenge

  8. Thick bronchi with Mucous plugs

  9. Pathophysiology

  10. Asthma Inflammation: Cells and Mediators Source: Peter J. Barnes, MD

  11. ALLERGIC TRIGGERS

  12. Triggers of Asthma (Irritants) • Infections • Chemicals • Diet/Medications • Strong Emotions • Exercise • Cold temperature • Exposure to smoke

  13. “Real Life” Variability in Asthma Acute inflammation symptoms subclinical Chronic inflammation Structural changes TIME Barnes PJ. Clin Exp Allergy 1996.

  14. diagnosis is obvious

  15. DIAGNOSIS OF ASTHMA • History and patterns of symptoms • Physical examination • Measurements of lung function

  16. Bronchial Asthma Asthma is diagnosed clinically by history and P/E In case of doubt : - Spirometry - Methacholine challenge test

  17. History • Tightness of the chest, cough & expectoration, wheeze • Comes in episodes, (recurrent ) • With exposure to allergens and irritants • History of asthma attacks • Relieve using salbutamol • Allergy in skin, eyes, nose • Family history of asthma or allergy

  18. Physical Examination • Wheeze /Rhonchi (no crackles) • Tachypnea (signs of allergy of skin , nose , eyes) • Remember Absence of symptoms at the time of examination does not exclude the diagnosis of asthma

  19. Peak Flow Meter

  20. Managing Asthma:Peak Expiratory Flow (PEF) Meters Allows the patient to assess the status of his or her asthma

  21. What Types of Spirometers Are Available? Spirotel Sensaire Satellite Renaissance KoKo Vitalograph 2120

  22. Spirometry: Obstructive Disease 5 4 Normal 3 Volume, liters FVC = 3.2L 94 % FEV1 = 1.8L 66 % FEV1/FVC = 56% 2 Obstructive 1 1 2 3 4 5 6 Time, seconds

  23. What is Asthma ? • A chronic inflammatory disorder of the airway with Infiltration of mast cells, eosinophils and lymphocytes in response to allergens • Airway hyper-responsiveness ( twitchy airways) • Recurrent episodes of wheezing, coughing and shortness of breath • Variable and often reversible airflow limitation (airway obstruction )

  24. ICS = inhaled cortico-steroids budesonide, fluticasone, beclomethasone, ciclosenide, mometasone • B2 Agonists : ( stimulants) Short acting : SABA salbutamol Long Acing : LABA: Rapid acting formeterol Non- Rapid acting salmeterol

  25. budesonide = Pulmicort • fluticasone = Flixotide • Ciclosenide = Alvesco

  26. Combinations: Symbicort : budesonide + formoterol Seretide: fluticasone + salmeterol Foster: beclomethasone + formeterol

  27. Anti-cholinergic drugs: Ipratropium (Atrovent) inhaler, solution for nebulizer Tiotropium (Spiriva) inhaler

  28. Reliever/ Rescue Salbutamol Bronchodilator (beta2agonist) • Quickly relieves symptoms (within 2-3 minutes) • Not for regular use

  29. Preventer/ Controller • Anti-inflammatory • Takes time to act (1-3 hours) • Long-term effect (12-24 hours) • Only for regular use (whether well or not well)

  30. Controller Drugs • Inhaled steroids • Leukotriene modifiers (montelukast) • Anti-IgE (omalizumab =Xolair ) • Systemic steroids

  31. Adults Patients with Asthma

  32. Rules of Two • Use of a quick-relief inhaler more than: 2 times per week • Awaken at night due to asthma symptoms more than: 2 times per month • Consumes a quick-relief inhaler more than: 2 times per year Need controller medication

  33. Poor Asthma Control why ? Before increasing medications, check: • Inhaler technique • Adherence to prescribed regimen • Environmental changes • Also consider alternative diagnoses

  34. Oral Slow onset of action Large dosage used Greater side effects Not useful in acute symptoms Why inhalation therapy? Inhaled Rapid onset of action Less amount of drug used Better tolerated Very effective

  35. summary • Asthma can be controlled but not cured • It can present in at any age. • It produces recurrent attacks of symptoms of SOB , cough with or without wheeze • Between attacks patients with asthma lead normal lives • In most cases there is some history of allergy in the family. • Understanding the disease, learning the technique and compliance with medications is the key for good control of asthma

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