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Bronchial Asthma

Bronchial asthma is a chronic inflammatory disorder of the airways characterized by episodes of wheezing, breathlessness, and coughing, often triggered by allergens and irritants. Diagnosis involves assessing lung function and symptoms, with management following a stepwise approach that includes relievers, preventers, and protectors. Treatment may escalate from inhaled short-acting beta-agonists to systemic corticosteroids, depending on the severity and control of the condition.

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12 views

Bronchial Asthma

Bronchial asthma is a chronic inflammatory disorder of the airways characterized by episodes of wheezing, breathlessness, and coughing, often triggered by allergens and irritants. Diagnosis involves assessing lung function and symptoms, with management following a stepwise approach that includes relievers, preventers, and protectors. Treatment may escalate from inhaled short-acting beta-agonists to systemic corticosteroids, depending on the severity and control of the condition.

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

Dr. Mohammad Enamul Haque


FRCP
Professor & Head,Department of Medicine
Gonoshasthaya Samaj Vittik Medical College
Asthma:Definition
Asthma is a chronic inflammatory
disorder of the airways associated
with airway hyper responsiveness to
various stimuli that leads to
recurrent episodes of wheezing ,
breathlessness, chest tightness and
coughing, particularly at night and
early morning.
• These episodes are usually associated
with widespread and variable airflow
obstruction – often completely or partially
reversible either spontaneously or with
treatment
Etiopathology
• Not exactly known
• Genetic predisposition important
factor
• Airways are inflammed and
hyperresponsive to some trigger
Asthma triggers
• Allergen
-Outdoor
-Indoor
• Irritants
• Upper resp tract infection
• Exercise
• Certain drugs
• Changes in season, weather
• Stress
Outdoor allergen

• Pollens
-flower
-grass
-trees

• Mold
Indoor allergen
• House dust mite
• Dander
• Insects
• Molds
• Hairy dolls
• Food allergens
How to diagnosis Bronchial
Asthma
FEV1 >or= 15% (200ml) increase
following administration of a bronchodilator
or trial of corticosteroid
FEV1 >20% diuranal variation on 3 days or
more in a week for 2 weeks in PEF diary
FEV1 > or = 15% decrease after 6 minutes
of exercise
Clinical Classification
• A. Intermittent asthma
• B. Persistent asthma
i) Mild persistent asthma
ii) Moderate persistent asthma
iii) Severe persistent asthma
• C. Acute severe asthma
Step-1, Intermittent asthma
• Symptoms less than once a week for 3
months
• Two or less than two nocturnal symptoms
in a month
• In between the episodes patient is
symptom free
• Pulmonary function test (PFT) is normal
Step-2, Mild persistent asthma
• Usually patient has nocturnal attack of
dyspnoea is more than 2 times per month

• Base line FEV1 is between 80% to 65% 0f


the predictive
Moderate persistent asthma
• Asthma attack almost every day
• In between attack FEV1 is between 65%
to 50% of the predictive value
Severe persistent asthma
• Dyspnoea to some extent continuously for
6 months or more
• Baseline FEV1 is less than 50% of the
predictive value
. Acute severe asthma
• Loss of control of any class or varient of
asthma
• May mild to life threatening attack
• After control may go back to original class
or varient
Stepwise approach to the
management of asthma
• Step-1
• Symptoms less than once a week for
• 3 months
• Fewer than two nocturnal attack per
• months
• Rx.
• Inhaled short acting beta-2 agonist as
• required
Step-2
• Uses inhaled beta 2- agonists three times
a week or more
 Reports symptoms three times or more
• Is awakened by asthma one night per
week
• Has experienced an exacerbation of
asthma in the last two years.
Rx of step 2
• In addition to as required beta 2 agonist-
• Regular inhaled anti-inflammatory drugs
Inhaled corticosteroids ( ICS )
Beclomethasone- Beclomin, Decomit
Fluticasone –Bexitrol F Inhaler/Ticamet
Budisonide - Budicort
-- 200-800 microgram/day
( ie. low dose steroid plus SABA )
Step-3
• If patients remain poorly controlled
despite regular use of ICS ( inhaled
corticosteroids)
• Then a thorough review should be
undertaken of
a) adherence,
b) inhaler technique
c) ongoing exposure to modifiable
aggravating factors.
Treatment of step 3
• Increase dose of ICS
• Add Long acting Beta 2 agonist or
• Use of fixed dose combination of ICS and
LABA
• Leukotriene receptor antagonist is less
effective than LABA but may facilitate a
reduction in the dose of ICS and control
exacerbation
• Oral theophylline may be recomended
Step 4
• Poor control on moderate dose of inhaled
steroid and add on therapy:
• ---addition of a forth drug
• Increase the dose of ICS 2000 microgram
• Nasal corticosteroid spray
• Oral leukotriene receptor antagonist
• Theophylline
• LABA
Step 5
• Continuous or frequent use of oral
steroid:-
• Use of oral prednisolone in the morning
as single dose
• Lowest dose should be used
• NB. Long term corticosteroids- > 3months/
• Receiving more than three to four courses
per year--- at risk of systemic side effects.
Adverse effect of systemic
corticosteroids.
• Aggravation of peptic ulcer disease when
used along with NSAID
• Diabetes mellitus
• Osteoporosis
• Perforation of viscus
• Reactivation of latent TB
Acute severe asthma
• Criteria:
PEF 33-50% predicted ( < 200L/min)
Respiratory rate 25 breath/min or more
Heart rate 110 beats/min or more
Inability to complete sentence in 1 breath
Management
• Oxygen inhalation
• High dose inhaled bronchodilator

• Systemic steroids
• IV fluids when needed
• Systemis antibiotics
Clinical classification
Special variant
• Seasonal asthma
• Exercise induced asthma
• Drug induced asthma
• Cough variant asthma
• Occupational asthma
Diagnosis
• Clinical feature

-Symptom

-Sign

• Lab. Test
-not always needed
Cardinal symptoms

• Cough
• Wheezing
• Chest tightness
• Breathlessness
History
• Cardinal symptomps
• Past medical history
• Drug history
• Family history
• Precipitating factor
• Relieving factor
Physical examination
• Tachypnea
• Hyperinflated chest
• Vesicular with Prolong expiration
• Diffuse rhonchi
Features of severity
• Difficulty in speech
• Silent chest
• Cyanosis
• Hypotension
• Confusion, drowsiness,
coma
Lab investigation
(not always needed)

• Full blood count


• Spirometry with reversibility
• Chest and sinus X-ray
• Serum IgE
4 Components of mx
Comp1=>Pt should learn
Comp 2=>avoid common allergen
• Tobacco smoke
-Stay away
• Known drug, food
-avoid
• Occupational
-reduce or avoid

• Cockroaches
-clean home
-insecticide
Cont....

• House dust mite


-wash bed linen weakly in hot water
-dry in sun/dryer
-replace carpet with hard flooring

• Outdoor pollen
-close window when pollen count high
• Indoor mold
-reduce dampness
-clean damp area
Component 3

• Asses Asthma control

• Treat to achieve control


-step care mx
• Monitor to maintain control
-self mx plan
Assessment of Asthma control
Mx approach based on control
Step care Mx………GINA 2009
Three types of Drugs
.

A) Relievers
B) Preventers
C) Protectors
Relievers (Bronchodilators)
 Relax smooth muscles
 relieve asthma symptoms.
They are:
1. Short acting -agonists
2. Short acting Aminophyllines
3. Anticholinergics
Preventers (Anti-inflammatory
medicines)
reduce or reverse the swelling in
the airways
prevent the initiation of
inflammation
 prevent asthma episodes.
Preventers are
I) Cromones
1) Nedocromil sodium,
2) Sodium Cromoglycate,
II) Corticosteroids
1) Inhaled
2) Oral Corticosteroids
III) Aminophylline, Theophylline &
Doxofylline
IV) Antileukotrienes
Protectors (Symptom controllers)
are long acting bronchodilator medicines
which prevent the recurrence of attacks
particularly nocturnal symptoms.
1) Long acting 2 agonist—Salmeterol/
Formetarol
2) Long acting Theophylline/Aminophylline,
3) Sustained release Salbutamol
 Inhaler
 Oralroute
 Parentaral route
 Suppository
 Sublingual
 Nebulizer solution
Step care Mx
Asthma exacerbation:
severity assessment
Asthma exacerbation:
Management
• High flow Oxygen
• Nebulisation with combined
Salbutamol+Ipratropium
• Multiple inhaled doses of salbutamol
-if nebulisation is unavailable
• Oral/I.V steroid
• Correct hypovolumia/dehydration
• Ventilation if indicated

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