1 / 40

Definition of asthma

Definition of asthma.

kass
Download Presentation

Definition of asthma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Definition of asthma “A chronic inflammatory disorder of the airways … in susceptible individuals, inflammatory symptoms are usually associated with widespread but variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible, either spontaneously or with treatment.” Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

  2. Diagnosis of asthma in adults • Symptoms (episodic/variable) • wheeze • shortness of breath • chest tightness • cough Consider the diagnosis of asthma in patients with some or all of these features Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

  3. Diagnosis of asthma in adults • Symptoms (episodic/variable) • wheeze • shortness of breath • chest tightness • cough • Signs • none (common) • wheeze – diffuse, bilateral, expiratory ( inspiratory) • tachypnea Consider the diagnosis of asthma in patients with some or all of these features Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

  4. Diagnosis of asthma in adults • Symptoms (episodic/variable) • wheeze • shortness of breath • chest tightness • cough • Signs • none (common) • wheeze – diffuse, bilateral, expiratory ( inspiratory) • tachypnea Consider the diagnosis of asthma in patients with some or all of these features • Helpful additional information • personal/family history of asthma or atopy • history of worsening after aspirin/NSAID, blocker use • recognised triggers – pollens, dust, animals, exercise, viral infections, chemicals, irritants • pattern and severity of symptoms and exacerbations Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

  5. Diagnosis of asthma in adults • Symptoms (episodic/variable) • wheeze • shortness of breath • chest tightness • cough • Signs • none (common) • wheeze – diffuse, bilateral, expiratory ( inspiratory) • tachypnea Consider the diagnosis of asthma in patients with some or all of these features • Helpful additional information • personal/family history of asthma or atopy • history of worsening after aspirin/NSAID, blocker use • recognised triggers – pollens, dust, animals, exercise, viral infections, chemicals, irritants • pattern and severity of symptoms and exacerbations • Objective measurements • >20% diurnal variation on 3 days ina week for 2 weeks on PEF diary • or FEV115% (and 200ml) increase after short acting ß2 agonist or steroid tablets • or FEV1 15% decrease after 6 minutes of running exercise • histamine or methacholine challenge in difficult cases Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

  6. Indications for referral ofadults with suspected asthma • Diagnosis unclear or in doubt • Unexpected clinical findings e.g. crackles, clubbing, cyanosis, heart failure • Spirometry or PEF measurements do not fit the clinical picture • Suspected occupational asthma • Persistent shortness of breath (not episodic, or without associated wheeze) • Unilateral or fixed wheeze • Stridor • Persistent chest pain or atypical features • Weight loss • Persistent cough and/or sputum production • Non-resolving pneumonia Diagnosis and natural history. Thorax 2003; 58 (Suppl I): i1-i92

  7. Non-pharmacologicalmanagement • Little evidence for effectiveness in preventing development of asthma, or reducing its impact • Early wheezing may be reduced with breast feeding and smoke-free environment • Allergen reduction may reduce impact of asthma • No consistent evidence supporting use of complementary or alternative treatments Non-pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  8. Asthma control Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  9. Asthma control Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  10. Asthma control Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  11. Stepwise management ofasthma in adults Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  12. Stepwise management of asthma in adults Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  13. Stepwise management of asthma in adults Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  14. Stepwise management ofasthma in adults Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  15. Stepwise management ofasthma in adults Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  16. Stepwise management ofasthma in adults Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  17. Overview: Pharmacologicalmanagement • Add inhaled long-acting 2 agonists rather than increasing the dose of inhaled steroids (above 800mcg/day in adults and 400mcg/day in children) • Step down therapy to lowest level consistent with maintained control Pharmacological management. Thorax 2003; 58 (Suppl I): i1-i92

  18. Delivery of ß2 agonists Inhaler devices. Thorax 2003; 58 (Suppl I): i1-i92

  19. Case discussion • BOB

  20. Delivery of inhaled steroids Inhaler devices. Thorax 2003; 58 (Suppl I): i1-i92

  21. Use and care of spacers Inhaler devices. Thorax 2003; 58 (Suppl I): i1-i92

  22. Patients at risk of developingnear fatal or fatal asthma Recognised by combination of: and Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  23. Patients at risk of developingnear fatal or fatal asthma Recognised by combination of: and Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  24. Patients at risk of developingnear fatal or fatal asthma Recognised by combination of: and Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  25. Lessons learnt fromstudies of asthma deaths • Many deaths from asthma are preventable – 88-92% of attacks requiring • hospitalisation develop over 6 hours • Factors include: • inadequate objective monitoring • failure to refer earlier for specialist advice • inadequate treatment with steroids Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  26. Assessment and management of acute asthma in adults in general practice Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  27. Assessment and management of acute asthma in adults in general practice Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  28. Treatment of acute asthmain adults in general practice Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  29. Hospital discharge andfollow up after acute asthma • GP review within 48 hours • Monitor symptoms and PEF • Check inhaler technique • Written asthma action plan • Modify treatment according to guidelines for chronic persistent asthma • Address factors that could have contributed to admission Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  30. Overview: Managementof acute asthma • Assess and act promptly in acute asthma • Admit patients with any feature of a life threatening or near fatal attack, or severe attack persisting after initial treatment • Measure oxygen saturation • Use steroid tablets • Primary care follow up required promptly after acute asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

  31. Patient education • Every asthma consultation provides an opportunity to review and reinforce self-management skills Patient education and self-management. Thorax 2003; 58 (Suppl I): i1-i92

  32. Practical tips forimproving concordance • Use open questions (e.g. “If we could make one thing better for your asthma what would it be?” to understand patient’s agenda • Make it clear you are listening and responding to the patient’s concerns and goals. • Reinforce practical information and negotiated treatment plans with written instruction • Consider reminder strategies • Recall patients who miss appointments Concordance and compliance. Thorax 2003; 58 (Suppl I): i1-i92

  33. Routine primary care Organisation and delivery of care. Outcomes and audit. Thorax 2003; 58 (Suppl I): i1-i92

  34. Monitoring morbidity: Royal College of Physicians three questions • Applies to all patients with asthma aged 16 and over. • Only use after diagnosis has been established. Outcomes and audit. Thorax 2003; 58 (Suppl I): i1-i92

  35. Case discussion • Susan

  36. The British Thoracic Society Scottish Intercollegiate Guidelines Network Special asthma Occupational asthma. Thorax 2003; 58 (Suppl I): i1-i92

  37. Occupational asthma • About 10% of adult onset asthma may be occupational • Occupational asthma is now the commonest industrial lung disease in the developed world • Patients with pre-existing asthma aggravated non-specifically by dust and fumes at work (work-aggravated asthma) should be distinguished from those with pre-existing asthma who become additionally sensitised to an occupational agent Occupational asthma. Thorax 2003; 58 (Suppl I): i1-i92

  38. Confirming and managing occupational asthma Occupational asthma. Thorax 2003; 58 (Suppl I): i1-i92

  39. Asthma in pregnancy • Continue treatment as usual • Monitor pregnant women with asthma closely to ensure therapy is appropriate for symptoms • Acute severe asthma in pregnancy should be treated as usual, but in a hospital setting • If anaesthesia is required, regional blockade is preferred Asthma in pregnancy. Thorax 2003; 58 (Suppl I): i1-i92

More Related