a Medical Power Point show from Er.Sulthan

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3. Hello Doctor! Medical Hand Book -11 From Er.Sulthan Asthma

4. ஹலோ டாக்டர்! குலசை சுல்தான் வழங்கும் மருத்துவ கையேடு-11 (ENGLISH)

5. Prevention is Better than Cure

6. Health Manager Thanks to Mayo Foundation for Medical Education and Research (MFMER). Presentation From Er.Sulthan

7. Asthma Definition Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of the bronchial walls tighten, and your airways produce extra mucus that blocks your airways. Signs and symptoms of asthma range from minor wheezing to life-threatening asthma attacks. Asthma can't be cured, but its symptoms can be controlled. Management includes avoiding asthma triggers and tracking your symptoms. You may need to regularly take long-term control medications to prevent flare-ups and short-term "rescue" medications to control symptoms once they start. Asthma that isn't under control can cause missed school and work or reduced productivity due to symptoms. Because in most people asthma changes over time, you'll need to work closely with your doctor to track your signs and symptoms and adjust your treatment as needed.

8. Symptoms • Asthma signs and symptoms range from minor to severe, and vary from person to person. You may have mild symptoms such as infrequent wheezing, with occasional asthma attacks. Between episodes you may feel normal and have no trouble breathing. Or, you may have signs and symptoms such as coughing and wheezing all the time or have symptoms primarily at night or only during exercise. • Asthma signs and symptoms include: • Shortness of breath • Chest tightness or pain • Trouble sleeping caused by shortness of breath, coughing or wheezing • An audible whistling or wheezing sound when exhaling • Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu Symptoms

9. Signs that your asthma is probably getting worse include: • An increase in the severity and frequency of asthma signs and symptoms • A fall in peak flow rates as measured by a peak flow meter, a simple device used to check how well your lungs are working • An increased need to use bronchodilators — medications that open up airways by relaxing the surrounding muscles • Work with your doctor to determine when you need to increase your medications or take other steps to treat symptoms of worsening asthma and get your asthma back under control. If your asthma keeps getting worse, you may need a trip to the emergency room. Your doctor can help you learn to recognize emergency signs and symptoms so you'll know when to get help.

11. Causes • It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors. • Asthma triggers are different from person to person. Exposure to various allergens and irritants can trigger signs and symptoms of asthma, including: • Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites • Respiratory infections, such as the common cold • Physical activity (exercise-induced asthma) • Cold air • Air pollutants and irritants such as smoke • Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs • Strong emotions and stress • Sulfites, preservatives added to some perishable foods • Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat • Menstrual cycle in some women • Allergic reactions to foods such as peanuts or shellfish

13. Risk factors Asthma is common, affecting millions of adults and children. A growing number of people are diagnosed with the condition each year, but it isn't clear why. A number of factors are thought to increase the chances of developing asthma. These include: A family history of asthma Frequent respiratory infections as a child Exposure to secondhand smoke Living in an urban area, especially if there's a lot of air pollution Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing Low birth weight Being overweight Normal Breath Breath with Asthma

14. When to seek medical advice Three key circumstances may lead you to talk to your doctor about asthma: If you think you have asthma. If you have frequent coughs that last more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early, especially in children, may prevent long-term lung damage and prevent worsening of the condition over time. To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good asthma control not only helps you feel better on a daily basis, but also can prevent a life-threatening asthma attack. If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't work for you. Asthma changes over time, and you'll need periodic adjustments to your treatment to manage your symptoms. Don't try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may even make your asthma worse.

15. Severe asthma attacks Severe asthma attacks can be life-threatening and require emergency treatment. If your asthma isn't getting better with quick-relief medications, seek emergency help right away. Work with your doctor ahead of time to determine what to do when your signs and symptoms worsen — and when you need emergency treatment. Signs of an asthma attack that needs emergency treatment include: Rapid worsening of shortness of breath or wheezing No improvement even after using short-acting bronchodilators Shortness of breath with minimal activity

16. Tests and diagnosis • Diagnosing asthma can be difficult. Signs and symptoms can range from mild to severe and are often similar to those of other conditions, including emphysema, early congestive heart failure or vocal cord problems. In children, it can be hard to differentiate asthma from wheezy bronchitis, pneumonia or reactive airway disease. • In order to rule out other possible conditions, your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems. You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. • Tests to measure lung function include: • Spirometry. This test measures the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath, and how fast you can breathe out. • Peak flow.A peak flow meter is a simple device that can be used at home to help detect subtle changes before you notice symptoms. If the readings are lower than usual, it's a sign your asthma may be about to flare up. Your doctor will give you instructions on how to track and deal with low readings.

17. Lung function tests often are done before and after taking a bronchodilator to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma. Other diagnostic tests to diagnose asthma include: Methacholine bronchial challenge. If you have asthma, inhaling a known asthma trigger called methacholine will cause mild constriction of your airways. A positive methacholine test supports a diagnosis of asthma. This test may be used if your initial lung function test is normal. Nitric oxide test. This test is sometimes used to diagnose and monitor asthma. It measures the amount of a gas called nitric oxide you have in your breath. If your airways are inflamed — a sign of asthma — you may have higher than normal levels of nitric oxide. This test isn't widely available. How asthma is classifiedTo classify your asthma severity, your doctor will evaluate your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests. Determining the severity level of your asthma will help your doctor choose the best treatment for you. Asthma severity often changes over time, requiring an adjustment to treatment.

20. Complications • Asthma may cause a number of complications, including: • Emergency room visits and hospitalizations for severe asthma attacks • Permanent narrowing of the bronchial tubes (airway remodeling) • Side effects from long-term use of some medications used to stabilize severe asthma

21. Treatments and drugs • Treatment for asthma generally involves avoiding the things that trigger your asthma attacks and taking one or more asthma medications. Treatment varies from person to person. • Most people with persistent asthma use a combination of long-term control medications and quick-relief medications, taken with a hand-held inhaler. • If your asthma symptoms are triggered by airborne allergens, such as pollen or pet dander, you may also need allergy treatment. • You may need to try a few different medications before you find what works best. • Because asthma changes over time, you will need to work with your doctor to monitor your symptoms and learn how to make needed adjustments. • Medications used to treat asthma include long-term control medications, quick-relief (rescue) medications and medications to treat allergies. The right medication for you depends on your age and symptoms, and what seems to work best to keep your asthma under control.

22. Long-term control medicationsIn most cases, these medications need to be taken every day. Types of long-term control medications include: Inhaled corticosteroids such as fluticasone (Flovent Diskus), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and others. These medications reduce airway inflammation and are the most commonly used long-term asthma medication. Unlike oral corticosteroids, these medications are considered relatively low risk for long-term corticosteroid side effects. You may need to use these medications for several days to weeks before they reach their maximum benefit. Long-acting beta-2 agonists (LABAs) such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer). These inhaled medications, called long-acting bronchodilators, open the airways and reduce inflammation. They are often used to treat persistent asthma in combination with inhaled corticosteroids. Long-acting bronchodilators should not be used for quick relief of asthma symptoms.

23. Leukotriene modifiers such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). These inhaled medications work by opening airways, reducing inflammation and decreasing mucus production. Cromolyn and nedocromil (Tilade). These inhaled medications reduce asthma signs and symptoms by decreasing allergic reactions. They're considered a second choice to inhaled corticosteroids, and need to be taken three or four times a day. Theophylline, a daily pill that opens your airways (bronchodilator). It relaxes the muscles around the airways. Quick-relief medicationsAlso called rescue medications, you use quick-relief medications as needed for rapid, short-term relief of symptoms during an asthma attack, or before exercise, if your doctor recommends it. Only use these medications as often as your doctor tells you to. If you need to use these medications too often, you probably need to adjust your long-term control medication. Keep a record of how many puffs you use each day. Types of quick-relief medications include: Short-acting beta-2 agonists, such as albuterol. These inhaled medications, called bronchodilators, ease breathing by temporarily relaxing airway muscles. They act within minutes, and effects last four to six hours.

25. Asthma is now the most common chronic childhood illness, affecting one in every 15 children. In North America, 5% of adults are also afflicted. In all, there are about 1 million Canadians and 15 million Americans who suffer from this disease.The number of new cases and the yearly rate of hospitalization for asthma have increased about 30% over the past 20 years. Even with advances in treatment, asthma deaths among young people have more than doubled.

26. Inflammation The first and most important factor causing narrowing of the bronchial tubes is inflammation. The bronchial tubes become red, irritated, and swollen. This inflammation increases the thickness of the wall of the bronchial tubes and thus results in a smaller passageway for air to flow through. The inflammation occurs in response to an allergen or irritant and results from the action of chemical mediators (histamine, leukotrienes, and others). The inflamed tissues produce an excess amount of "sticky" mucus into the tubes. The mucus can clump together and form "plugs" that can clog the smaller airways. Specialized allergy and inflammation cells (eosinophils and white blood cells), which accumulate at the site, cause tissue damage. These damaged cells are shed into the airways, thereby contributing to the narrowing.

27. Ipratropium (Atrovent). Your doctor might prescribe this inhaled anticholinergic for the immediate relief of your symptoms. Like other bronchodilators, ipratropium relaxes the airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis. Oral and intravenous corticosteroids to treat acute asthma attacks or very severe asthma. Examples include prednisone and methylprednisolone. These medications relieve airway inflammation. They may cause serious side effects when used long term, so they're only used to treat severe asthma symptoms. Medications for allergy-induced asthma. These decrease your body's sensitivity to a particular allergen or prevent your immune system from reacting to allergens. Allergy treatments for asthma include: Immunotherapy. Allergy-desensitization shots (immunotherapy) are generally given once a week for a few months, then once a month for a period of three to five years. Over time, they gradually reduce your immune system reaction to specific allergens. Anti-IgE monoclonal antibodies, such as omalizumab (Xolair). Thismedication reduces your immune system's reaction to allergens. Xolair is delivered by injection every two to four weeks.

28. Albuterol inhaler changes: Know what to expectThe Food and Drug Administration (FDA) has required that metered-dose albuterol inhalers that use chlorofluorocarbon (CFC) propellent be replaced with hydrofluoroalkane (HFA) inhalers by the end of 2008. HFA inhalers work as well as CFC inhalers and are as safe, but they don't harm the ozone layer. If you're used to using a CFC inhaler, talk to your doctor about making the switch to an HFA inhaler. There are a few differences you should know about: Your HFA inhaler may have a different taste and feel from your older CFC inhaler. HFA inhalers have a less forceful spray than the older CFC inhalers. Make sure you know how to use your inhaler correctly - otherwise, you may not get the full dose of medication with each spray. HFA inhalers are more costly than the older, generic albuterol CFC inhalers. HFA inhalers should be cleaned with water every week.

29. Treatment by severity for better control: A stepwise approachTreatment based on asthma control can help you manage your asthma. Asthma treatment should be flexible and based on changes in symptoms, which should be assessed thoroughly each time you see your doctor. Then, treatment can be adjusted accordingly. For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma is not well controlled or getting worse, your doctor may increase your medication and recommend more frequent visits.

30. Prevention • Working together, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks. • Develop a written asthma plan. With your doctor and health care team, write a detailed plan for taking maintenance medications and managing an acute attack. Then be sure to follow your plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general. • Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.

31. Monitor your breathing.You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure your peak airflow with a home peak flow meter. • Identify and treat attacks early.If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms. When your peak flow measurements decrease and alert you to an impending attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.

32. Don't let up on your medication program. Just because your asthma seems to be improving, don't change anything without first talking to your doctor. It's a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you're using your medications correctly and taking the right dose.

33. Lifestyle and home remedies • Although many people with asthma rely on medications to relieve symptoms and control inflammation, you can do several things on your own to maintain overall health and lessen the possibility of attacks. • Avoid your triggersTaking steps to reduce your exposure to things that trigger asthma symptoms is a key part of asthma control. Here are some things that may help: • Use your air conditioner. Air conditioning helps reduce the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Air conditioning also lowers indoor humidity and can reduce your exposure to dust mites. If you don't have air conditioning, try to keep your windows closed during pollen season. • Decontaminate your decor. Minimize dust that may aggravate nighttime symptoms by replacing certain items in your bedroom. For example, encase pillows, mattresses and box springs in dust-proof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds. • Maintain optimal humidity. Keep humidity low in your home and office. If you live in a damp climate, talk to your doctor about using a dehumidifier. • Reduce pet dander. If you're allergic to dander, avoid pets with fur or feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.

34. If it's cold out, cover your face. If your asthma is worsened by cold, dry air, wearing a face mask can help. Stay healthyTaking care of yourself and treating other conditions linked to asthma will help keep your asthma under control. A few things you can do include: Exercise. Having asthma doesn't mean you have to be less active. Treatment can prevent asthma attacks and control symptoms during activity. Regular exercise can strengthen your heart and lungs, which helps relieve asthma symptoms. Aim for 30 minutes of exercise on most days. If you've been inactive, start slowly and try to gradually increase your activity over time. Maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts you at higher risk of other health problems. Control heartburn and gastroesophageal reflux disease (GERD). It's possible that the acid reflux that causes heartburn may damage lung airways and worsen asthma symptoms. If you have frequent or constant heartburn, talk to your doctor about treatment options. You may need treatment for GERD before your asthma symptoms improve.

35. Hyperreactivity (Hypersensitivity) In patients with asthma, the chronically inflamed and constricted airways become highly sensitive, or reactive, to triggers such as allergens, irritants, and infections. Exposure to these triggers may result in progressively more inflammation and narrowing.

36. Irritants • respiratory infections (caused by viral "colds," bronchitis, and sinusitis) • drugs, such as aspirin, other NSAIDs (nonsteroidal antiinflammatory drugs), and beta blockers (used to treat blood pressure and other heart conditions) • tobacco smoke • outdoor factors, such as smog, weather changes, and diesel fumes • indoor factors, such as paint, detergents, deodorants, chemicals, and perfumes • Night time • GERD (gastroesophageal reflux disorder) • exercise, especially under cold dry conditions • work-related factors, such as chemicals, dusts, gases, and metals • emotional factors, such as laughing, crying, yelling, and distress • hormonal factors, such as in premenstrual syndrome

38. We Pray For Your Good Health Action is the proper fruit of knowledge. The best of all medicines is resting and fasting Health is a blessing that money cannot buy. From Er.Sulthan