Bronchial Asthma Definition Patho-physiology Diagnosis Management
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Transcript of Bronchial Asthma Definition Patho-physiology Diagnosis Management
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