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Bronchial Astma

Bronchial Astma. Ibrahim Tawhari. Prepared by:. Scernario :. Khalid 14 years old come to the clinic c/o shortness of breath for one day duration. He is a known asthmatic patient for more than 8 years, he visits clinic frequently.

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Bronchial Astma

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  1. Bronchial Astma Ibrahim Tawhari. Prepared by:

  2. Scernario: • Khalid 14 years old come to the clinic c/o shortness of breath for one day duration. • He is a known asthmatic patient for more than 8 years, he visits clinic frequently. • His school performance is below average, with frequent absence from school due to his illness.

  3. What is Bronchial Asthma?? • It is a chronic inflammatory disorder of the airways resulting in EPISODES of: • Reversible bronchospasm airflow obstruction. • Associated with airway HYPER-RESPONSIVENESS to endogenous or exogenous stimuli.

  4. ASTHMA IN KSA

  5. Asthma in KSA: • A common problem especially in children. • The prevalence of asthma among school children in KSA: • Range: 4%-23%. • Riyadh: 10%. • Jeddah: 12%

  6. PATHOPHYSIOLOGY

  7. PATHOPHYSIOLOGY

  8. PATHOPHYSIOLOGY: • During an acute asthmatic attack:

  9. PATHOPHYSIOLOGY:

  10. TRIGGERS

  11. TRIGGERS: • URTIs. • Allergens / Irritants: Mould Pollens Pet dander House Dust Feather Smoking Air Pollution

  12. TRIGGERS: • Drugs: • Emotion & Anxiety: NSAIDs -Blockers Aspirin

  13. TRIGGERS: • Others: Cold Air Exercises GERD

  14. SIGNS & SYMPTOMS…

  15. SYMPTOMS & SIGNS: • Tachypnea, • Wheezing, • Chest tightness, • Cough (especially nocturnal), sputum production.

  16. RED FLAGS…

  17. RED FLAGS: Expiratory Effort Fatigue Cyanosis Silent Chest  LOC

  18. Respiratory Distress: • Nasal flaring, tracheal tug • Inability to speak • Accessory muscle use, intercostalindrawing • Pulsusparadoxus

  19. DIAGNOSIS

  20. DIAGNOSIS: • History: • Is it the first time??? Recurrent??? • If first attack  Hyperactive airway disease. • SOB, Cough, sputum,… • Nocturnal attacks? • Effect on daily activities?? • Frequency? • Look for any triggers… • Family History… • Drug History…

  21. DIAGNOSIS: • History: • Atopic manifestation: Atopy Triad

  22. DIAGNOSIS: • P/E: • General Appearance, • Vital signs: Tachypnea, pulsusparadoxus, fever,…??? • General Examination: • Cyanosis, eczema, nasal polyps, URTI, … • Local Examinations: • Inspection: • Palpation: • Auscultation: • Percussion

  23. DIAGNOSIS: • Investigations: • O2 saturation. • ABGs: •  PO2 during attack (V/Q mismatch). •  PCO2 in mild asthma (hyperventilation)… • But, normal or PCO2 ominous sign (resp. muscle fatigue). • PFTs: • May not be possible during attacks… • Done when patient is stable…

  24. DIAGNOSIS: • Investigations: • PFTs: • Spirometry: • FEV1: • Improvement with medications..

  25. MANAGEMENT

  26. Management: • Non-Pharmacologic Management: • Avoid allergens… • Education of the patient: • Features of disease… • Goal of management… • How to do self monitoring… • Red flags…

  27. Management: • Pharmacologic Management: • Symptomatic relief in ACUTE ATTACKS: • Short acting 2-agonists: albuterol, terbutalin, mataprotrenol,… • Anticholinergic bronchodilators… • Steroids… • Long acting 2-agonists: Salmetrol, formetrol,…

  28. Management: • Pharmacologic Management: • CHRONIC MANAGEMENT: • Long Term Prevention of Attacks… • Inhaled or oral steroids… • Anti-allergic: Na chromoglycate, Nidocromile,.. • Long acting 2-agonists: Salmetrol, Formetrol,… • Aminophyllins… • LT receptors antagonists: zileuton, zafirlukast, montilukast,..

  29. Management:

  30. Follow up

  31. Criteria of Controlled Asthma:

  32. Assessment of Control:

  33. THE END…. Thanks…

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