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Asthma 2.1

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4 views

Asthma 2.1

Uploaded by

njanevidepettu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Asthma Overview

Definitions

 Asthma: A reversible obstructive lung disease characterized by bronchoconstriction,


inflammation, and bronchial hyper-responsiveness to various stimuli 1.

Pathophysiology

 Asthma involves an IgE-mediated response leading to:

o Bronchoconstriction: Narrowing of airways.

o Inflammation: Swelling and mucus production.

o Bronchial Hyper-responsiveness: Exaggerated bronchoconstriction in response to


triggers like allergens and smoke 2.

Risk Factors

 Demographics: More common in males during childhood; prevalence equalizes after age 20 3.

 Genetic Factors: Family history of allergic diseases (e.g., eczema, allergic rhinitis) increases risk 4.

 Environmental Factors: Exposure to air pollution and secondhand smoke can heighten risk 5.

Clinical Manifestations

 Key symptoms include:

o Wheezing: High-pitched sound during expiration.

o Cough: Often worse at night.

o Dyspnea: Shortness of breath 5.

 Symptoms are episodic and can be triggered by allergens, exercise, or cold air 6.

Physical Examination Findings

 Wheezing: Prolonged expiration with high-pitched sounds.

 Hyper-resonance: Due to air trapping in lungs.

 Use of Accessory Muscles: Increased effort during breathing 7.

Diagnosis

 Pulmonary Function Testing (PFT): Spirometry is the gold standard. Look for:

o Decreased FEV1/FVC Ratio: Less than 0.70 indicates obstructive disease 8.

 Bronchodilator Challenge: Administer albuterol; a significant improvement (≥12% increase in


FEV1) confirms asthma 9.
 Bronchoprovocation Testing: Use methacholine to induce bronchoconstriction; a ≥20% decrease
in FEV1 indicates asthma 10.

Treatment Guidelines

 Medications:

o SABAs (Short-Acting Beta-2 Agonists): First-line for acute exacerbations (e.g.,


albuterol) 11.

o Inhaled Corticosteroids: First-line for chronic maintenance (e.g., fluticasone) 12.

o LABAs (Long-Acting Beta-2 Agonists): Used in combination with inhaled corticosteroids


for maintenance therapy 13.

National Asthma Education and Prevention Program (NAEPP) 2020 Guidelines

 Stepwise Approach:

o Step 1: Intermittent asthma - SABA as needed.

o Step 2: Mild persistent - Low-dose inhaled corticosteroid + SABA.

o Step 3: Moderate persistent - Low-dose inhaled corticosteroid + LABA.

o Step 4: Severe persistent - Medium-dose inhaled corticosteroid + LABA.

o Steps 5-6: Consider higher doses and biologics for refractory cases 14.

Key Points to Remember

 Samter's Triad: Asthma, chronic rhinosinusitis with nasal polyps, and aspirin sensitivity 15.

 Classic Symptoms: Wheezing, cough, and dyspnea .

 Never Use LABAs Alone: Always combine with inhaled corticosteroids 14.

This summary provides a comprehensive overview of asthma, covering definitions, pathophysiology, risk
factors, clinical manifestations, diagnosis, treatment guidelines, and key points to remember.

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