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DR. SRINIVASAN

ASTHMA. DR. SRINIVASAN. Goals of the lecture. Definition of asthma & brief pathogenesis Initial diagnosis and ddx Factors that can trigger or aggrevate asthma Classify asthma and assessment of control Commonly used medications. What is asthma ?.

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DR. SRINIVASAN

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  1. ASTHMA DR. SRINIVASAN

  2. Goals of the lecture Definition of asthma & brief pathogenesis Initial diagnosis and ddx Factors that can trigger or aggrevate asthma Classify asthma and assessment of control Commonly used medications

  3. What is asthma ? • Leading chronic illness in childhood major public health problem • school absenteeism 15 million days a year • Hyper-reactivity of airways to stimuli • Widespread bronchial obstruction and inflammation • High degree of reversibility of the process

  4. ASTHMA IS MANAGEABLE IF CHILDREN AND FAMILIES HAVE ACCESS TO QUALITY HEALTH CARE & EVIDENCE BASED INTERVENTIONS HAVE PROVEN TO BE EFFECTIVE

  5. Prevalence • Accounts for 2.2 million pediatrician visits per year • 2-10 % children less than 10 are affected • incidence higher in low income areas • 60% of children symptom free by 20 years • 80% have symptoms by 5 years • 1 parent 25% risk 2 parents 50% risk

  6. Pathophysiology of Asthma INFLAMMATION AIRWAY HYPERRESPONSIVENESS AIRWAY OBSTRUCTION CLINICAL SYMPTOMS

  7. GENETIC FACTORS • CYTOKINE RESPONSE PROFILES • ENVIRONMENT • ALLERGENS • POLLUTION • INFECTIONS • EXERCISE • STRESS ALTERED INNATE AND IMMUNE RESPONSE LOWER AIRWAY INFECTION PERISISTENT WHEEZING AND ASTHMA

  8. Inhaled allergen, osmotic stm Releases IgE -attaches to mast cells Activates and releases macrophages and mast cells and lymphocytes (imbalance between TH1 and TH2 increased TH2) Inflammatory mediators released like leukotrienes and cytokines (mainly IL4, IL5,IL6, IL9) release of eosnophils from bone marrow have inflamatory enzymes and release leukotrienes Stimulates bronchoconstriction and airway inflammation and mucous hypersecretion Sloughing of Epithelium

  9. Cytokine imbalance • Increase TH2 • Widespread Ab use • Western Lifestyle • Urban Environment • Sensitization to • dust mites & • roaches • Increase Th1 • Presence of older siblings • Early exposure to day care • Rural environment • Exposure to dander of dog • and cat early in life Th1 Th2 CYTOKINE BALANCE Protective immunity Allergic diseases

  10. The Importance of Genetics • Genetics plays an important role - no genes to date identified

  11. WHY DO WE HAVE TO CONTROL ASTHMA? • Persistent severe inflammation leads to airway remodeling and permanent loss of function which is clinically significant

  12. COMPONENTS IN MANAGEMENT OF ASTHMA • DIAGNOSIS OF ASTHMA • IDENTIFY COMORBID CONDITIONS PRECIPITATING FACTORS • ASSESMENT AND MONITORING • EDUCATION FOR PARTNERSHIP IN CARE • ENVIRONMENTAL CONTROL • PHARMACOLOGICAL THERAPY

  13. Signs and symptoms • Nocturnal cough, chest tightness • wheezing, sob, tachypnea, tachycardia, pulses paradoxus • abdominal pain • vomiting relieves symptoms • severe obstruction- barrel chest • Symptoms worsen with allergen exposure • spirometry for kids more than 5 years of age

  14. Differential Diagnosis • Allergic rhinitis or sinusitis, GERD • FB • Large airway obstruction like laryngomalacia • bronchiolitis • CF • Heart disease • Aspiration

  15. Assessment and monitoring CONTROL SEVERITY IMPAIRMENT RISK

  16. Environmental Control Control of House dust and mites • Humidity 30-50% inside house • Remove carpet and stuffed toys • Wash toys in water with soap or leave in freezer • Animal out of the bedroom • Encase mattress and pillows in dust proof covers • Wash sheets and blankets weekly with hot water

  17. Environmental control (Cont.) Roaches • Food out of bedrooms • Food and Garbage contained • use gel or spray Pollen Cold air

  18. Patient Education Education in schools and health fairs AAP(Asthma Action Plan) Encourage positive lifestyle behaviors

  19. The End Any questions?

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