ASTHMA

BYDR Olubayode Akinbi

• Definition• Asthma triggers• Signs and Symptoms• Pathogenesis• Types• Diagnose• Management

Definition

A reversible chronic inflammatory airway disease that is characterized by bronchial hyper-responsiveness of the airways to various stimuli leading to wide spread bronchoconstriction, airflow limitation and inflammation of the bronchi causing symptoms of cough, wheeze, chest tightness and dyspnea.

EPIDEMIOLOGY• Asthma affects 5-10% of the population or an estimated

23.4 million persons, including 7 million children.• Annually, WHO has estimated that 15 million disability-

adjusted life-years are lost and 250,000 asthma deaths are reported worldwide

• Asthma predominantly occurs in boys in childhood, with a male-to-female ratio of 2:1 until puberty, when the male-to-female ratio becomes 1:1.

• Asthma prevalence is greater in females after puberty, and the majority of adult-onset cases diagnosed in persons older than 40 years occur in females.

EPIDEMIOLOGY

Activators/Triggers

• Allergens such as pollen, dust mites, cockroaches, and cat dander.

• Infection and cold air• Emotional stress or Exercise and occupation• Catamenial ( related to menstrual cycle)• Aspirin,NSAIDS, beta blockers, histamine, any

nebulized medication, tobacco smoke• Gastroesophageal reflux disease (GERD)

Early warning signs

• Cough• Mood Changes• Change in facial

appearance• Breathing changes• Verbal complaints• Itchy chin or neck• Itchy, watery, or

glassy eyes

• Runny nose• Head stopped up• Sneezing• Dark Circles under

eyes• Getting out of

breath• Chest hurts

Symptoms of Asthma Flare-up

• Cough• Wheeze• Shortness of breath• Chest tightness• Retractions

• Symptoms worse at night• Eczema or atopic dermatitis on physical

examination• Increased length of expiratory phase of

respiration • Increased use of accessory respiratory muscles

(e.g intercostals)

Asthma Classification

The National Asthma Education and Prevention Program has classified asthma as:• Intermittent.• Mild persistent.• Moderate persistent.• Severe persistent.These classifications are based on severity, which is determined by symptoms and lung function tests

INITIAL MANAGEMENT OF CHILDREN WHO HAVE ACUTE ASTHMA

TREATMENT MILD EPISODE MODERATE EPISODE SEVERE/LIFE-THREATENING

Hospital admission necessary

Probably not required Probably required Yes, consider intensive care

Supplementary O2

Probably not required May be requiredMonitor SaO2

Required. Monitor SaO2, Arterial Blood Gases may be required

Salbutamol (100 µg per puff)

4-6 puffs (children< 6 yrs)8-12 puffs (children ≥ 6yrs)Review in 20mins

6 puffs (children< 6 yrs)12 puffs (children ≥ 6yrs)If initial response is inadeq, repeat at 20 mins interval for further 2 doses; then give every 1-4 hrs

6 puffs (children< 6 yrs) or 12 puffs (children ≥ 6yrs) every 20mins for 3 doses in 1st hour. If episode is life-threatening, use continous nebulized salbutamol. If no response, bolus IV salbutamol (15µg/kg) over 10mins, then 1µg/kg/min thereafter

Ipratropium (20 µg per puff)

Not necessary Optional 2 puffs (children< 6 yrs) or 4 puffs (children ≥ 6yrs) every 20mins for 3 doses in 1st hour or use nebulized ipratropium

National Asthma Council Australia. Asthma management handbook, 2006

INITIAL MANAGEMENT OF CHILDREN WHO HAVE ACUTE ASTHMA Contd

TREATMENT MILD EPISODE MODERATE EPISODE SEVERE/ LIFE- THREATENING

Systemic corticosteroids

Yes (consider) Oral prednisolone (1mg/kg daily for up to 3 days)

Oral prednisolone (1mg/kg/dose) daily for up to 5 daysMethylprednisolone IV (1mg/kg) every 6hrs on day 1, every 12hrs on day 2, then daily

Magnesium No No MgSO4 50% 0.1mL/kg (50mg/kg) IV over 20mins, then 0.06 mL/kg/h (30mg/kg/h); target serum 1.5-2.5 mmol/L

Aminophylline No No Only in ICU; loading dose 10mg/kg; maintanance 1.1mg/kg/h if < 9 yrs or 0.7mg/kg/h if ≥ 9yrs

Chest radiograph Not necessary unless focal signs present

Not necessary unless focal signs present

Necessary if no response to initial therapy or pnuemothorax is suspected

Observations Observe for 20mins after dose

Observe for 1 hour after last dose Arrange for admission to hospital

National Asthma Council Australia. Asthma management handbook, 2006

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