Bronchial Asthma

Definition

Patho-physiology

Diagnosis

Management

What is Asthma ?What is Asthma ? A chronic inflammatory disorder of the

airway

Infiltration of mast cells, eosinophils and lymphocytes in response to allergens

Airway hyperresponsiveness

Recurrent episodes of wheezing, coughing and shortness of breath

Variable and often reversible airflow limitation ( airway obstruction )

Pathology of AsthmaPathology of Asthma

Inflammation

Airway Hyper-responsiveness Airway Obstruction

Symptoms of Asthma

Source: Peter J. Barnes, Source: Peter J. Barnes, MDMD

Mechanisms: Asthma Inflammation

During an asthma attack…During an asthma attack…

04/19/23

Asthma Microscopic PathologyAsthma Microscopic Pathology

Obstructed

Inflammed

Bronchi

Before 10 Minutes After Allergen Challenge

BronchoconstrictionBronchoconstriction

04/19/23

Thick bronchi with Mucous plugsThick bronchi with Mucous plugs

PathophysiologyPathophysiology

Source: Peter J. Barnes, Source: Peter J. Barnes, MDMD

Asthma Inflammation: Cells and Mediators

ALLERGIC TRIGGERSALLERGIC TRIGGERS

Triggers of Asthma AttacksTriggers of Asthma Attacks

Narrowing of airways occurs in response to inflammation or hyperresponsiveness to triggers, including:

Allergens

Infections

Diet/Medications

Strong Emotions

Exercise

Cold temperature

Exposure to irritants

Chronic inflammationChronic inflammation

Structural changesStructural changes

AcuteAcuteAcuteAcuteinflammationinflammationinflammationinflammation

TIMETIMETIMETIME

Barnes PJ. Clin Exp Allergy 1996.

“Real Life” Variability in Asthma“Real Life” Variability in Asthma

symptoms

subclinical

DIAGNOSIS OF ASTHMA

History and patterns of symptoms

Physical examination

Measurements of lung function

Bronchial Asthma

Asthma is diagnosed clinically by history and

P/E

In case of doubt :

- PFT

- Methacholine challenge test

Physical ExaminationPhysical Examination

Wheeze /Rhonchi (no crackles) Tachypnea ( skin , nose , eyes signs of allergy)

Remember Absence of symptoms at the time of examination does not exclude the diagnosis of asthma

What Types of Spirometers

Are Available?

                 

Simplicity Spirotel Sensaire Satellite SpiroCard

MicroPlus Renaissance KoKo Vitalograph

2120

FlowFlow

(l/s)(l/s)

Volume (l)Volume (l)

-2-2

00

-4-4

11

33

22

44

55

21 3 4 5

-6-6

Spirometry: Flow-Volume Loops in AsthmaSpirometry: Flow-Volume Loops in Asthma

Peak Flow MeterPeak Flow Meter

ICS = inhaled cortico-steroids

budesonide, fluticasone, beclomethasone, mometasone,

ciclosenide

B2 Agonists : ( stimulants)

Short acting : SABA salbutamol

Long Acing : LABA:

Rapid acting formeterol

Non- Rapid acting salmeterol

budesonide = Pulmicort

fluticasone = Flixotide

Ciclosenide = Alvesco

Combinations:

Symbicort : budesonide + formoterol

Seretide: fluticasone + salmeterol

Reliever/ RescueReliever/ Rescue

Bronchodilator (beta2 agonist)

Quickly relieves symptoms (within 2-3 minutes)

Not for regular use

Anti-inflammatory

Takes time to act (1-3 hours)

Long-term effect (12-24 hours)

Only for regular use

(whether well or not well)

Preventer/ ControllerPreventer/ Controller

Controller MedicationsController Medications

Inhaled glucocorticosteroids

Leukotriene modifiers

Systemic glucocorticosteroids

Anti-IgE

Inhaled glucocorticosteroids

Leukotriene modifiers

Systemic glucocorticosteroids

Anti-IgE

Adults Patients with AsthmaAdults Patients with Asthma

Rules of TwoRules of Two

Use of a quick-relief inhaler more than: 2 times per week

Awaken at night due to asthma symptoms more than: 2 times per month

Consumes a quick-relief inhaler more than: 2 times per year

Need controller medication

Poor Asthma Control why ?Poor Asthma Control why ?Poor Asthma Control why ?Poor Asthma Control why ?

Before increasing medications, check:Before increasing medications, check:

Inhaler techniqueInhaler technique

Adherence to prescribed regimenAdherence to prescribed regimen

Environmental changesEnvironmental changes

Also consider alternative diagnosesAlso consider alternative diagnoses

Why inhalation therapy?Why inhalation therapy?

Oral

Slow onset of action

Large dosage used

Greater side effects

Not useful in acute

symptoms

Inhaled Rapid onset of

actionLess amount of

drug used

Better tolerated

Very effective

summarysummary Asthma can be controlled but not cured

It can present in anybody at any age.

It produces recurrent attacks of symptoms of SOB , cough with or without wheeze

Between attacks people with asthma lead normal lives as

anyone else

In most cases there is some history of allergy in the family.

Understanding the disease, learning the technique and compliance with medications is the key for good control of asthma