ASTHMA

ANAND.M

09’ALTHEANZ

A patient named Ramani , 45yrs old came with

complaints of breathlessness, cough and

chest tightness. On history, we came to know

that the patient visited a stone quarry a day

before. On serum examination the blood IgE

level & eosinophil count is high. What would

be the diagnosis and management ?

ASTHMA

Asthma is characterized by chronic

airway inflammation and increased

airway hyper responsiveness leading

to symptoms of wheeze ,cough, chest

tightness and dyspnoea.

It is characterised functionally by the

presence of air flow obstruction-

variable over short period reversible

with treatment

ETIOLOGY

Complex and multiple environmental

and genetic determinants.

Hygiene hypothesis -decreased

infection in early life

Infections – respiratory synctial

viruses

Allergens – pet exposure , food

particle

Air pollution

ETIOLOGY

PATHO PHYSIOLOGY

• Reverses spontaneously on treatmentAirway

limitation

• Exaggerated broncho-constriction

Airway hyper-

reactivity

• Edema

• Smooth muscle hypertrophy, hyperplasia

• Mucous plugging

Airway inflammation

Inhaled allergens interact with mast cells

Histamine and cysteinyl leukotrienes

Bronchoconstriction

In case of inhaled allergens

Influx of inflammatory cells

Transformation and participation of airway structural cells

Secretion of cytokines , chemokines and growth factors

In persistent asthma

CLINICAL FEATURES

Recurrent episodes of wheeze ,cough,

chest tightness and dyspnoea.

Nocturnal asthma

Cough-variant asthma

Aspirin sensitive asthma

Occupational asthma

INVESTIGATIONS

Pulmonary function tests

Radiological examination

Skin prick test

Measurement of FEV and VC by Spirometry

Hyper inflammation, lobar collapse and mucous occlusion

Serum IgE examination

5. Addition of regular oral corticosteroid therapy

4. High dose inhaled corticosteroids and regular bronchodilators

3. Low to moderate doe inhaled corticosteroids plus long acting inhaled β2-adrenoceptor

agonists or leucotriene receptor antagonist

2. Low dose inhaled corticosteroids or other anti-inflammatory agents

1. Occasional use of inhaled short acting β2-adrenoceptor agonists

Step wise management of asthma

Thank you