2. INTRODUCTION
• It is obstructive pulmonary disease.
• Defined as chronic inflammatory disorder of
airways characterized by airway hyper
responsiveness and airflow obstruction leading
to recurrent episodes of coughing, wheezing,
breathlessness & chest tightness…
3. ETIOLOGY
1) Airway Hyperactivity
• It is tendency of airway to narrow in response to
triggers that have little or no effect in normal
individuals.
• Causes of airway hyperactivity
• Airway inflammation
• Degree of airway narrowing
• Neurogenic mechanisms
7. EARLY OR IMMEDIATE BRONCHO
CONSTRICTOR RESPONSE
• Occurs shortly after exposure to allergen within
first 15 min - 1hour.
• Caused by mediators of immediate
hypersensitivity reaction; mast cells/basophils,
release mediators and causes inflammation that
leads to airway hyperactivity.
8. LATE BRONCHO CONSTRICTOR RESPONSE
• Occurs late after exposure to allergen about
4-6 hours after.
• Caused by influx of inflammatory cells and
then releasing mediators which causes
inflammation which leads to airway
hyperactivity.
12. • Daily,
Throughout
Day
• Asthma Attack
Daily
• Not Throughout
Day
• Greater Than 2
Days/Week
• Not Daily
• Asthma Attack
• Less Than 2
Days/Week
Intermittent
Mild
Persistent
Sever
Persistent
Moderate
Persistent
15. • Clinical History
• Demonstration of airflow obstruction by using spirometry or peak flow
meter.
• If
• FEV ≥15% increases after administration of
bronchodilator, Asthma is present.
• > 20% diurnal variation on ≥ 3 days in week for
2 weeks on PEF, Asthma is present.
• FEV ≥ 15% decrease after 6 min exercise,
Asthma is present.
16. OTHER INVESTIGATIONS
• Measurement of allergic status
• Presence of atopy by skin prick test
• Measurement of Ig E
• FBC, for eosinophilia
• Radiological exam
• CXR often normal or show hyperinflation of lung.
18. STEP 1
•Occasional use of inhaled
short acting B2 – adrenal
receptor agonist
bronchodilators
• E.g. Salbutamol, Terbutaline (in mild intermittent asthma)
20. STEP 3 (add on Therapy)
• Change short acting beta agonist with long acting beta
agonist(LABA).
Inhaled
Corticosteroids
Long Acting
Beta agonists
21. STEP 4 (Addition of 4th Drug)
• Used in those whose poor control on moderate dose of inhaled
corticosteroid & LABA.
• Discontinue the LABA from ICS and give any of following.
22. STEP 5
• continues use of oral steroids for control of symptoms
• Osteoporosis caused by corticosteroid can be prevented by
giving bisphosphonates.
• In atopic Patients, omalizumab (monoclonal antibody
directed against I g E.
• Note: once asthma is controlled slowly reduce dose of
corticosteroids.
24. Management of MILD to MODERATE Asthma
•Short course of rescue
oral corticosteroid
•(Prednisolone 30-60 mg
daily)
25. Management of STATUS ASTHAMATICUS
(Features)
•PEF = 33-50%
•Respiratory Rate ≥ 25
breaths/minute
•Heart rate ≥ 110 beats/minute
•Inability to complete sentence in
one breath
26. TREATMENT OF STATUS ASTHAMATICUS
• Oxygenation (O2 saturation should be > 92%)
• High dose inhaled bronchodilators
• SHORT ACTING B2 AGONIST ARE DRUG OF CHOICE
• Salbutamol
• Ipratropium bromide
• Systemic corticosteroids
• Orally; Prednisolone
• IV; Hydrocostisone
Still No
Response….
Go for
INTUBATION
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