Asthma Case Presentation

What is asthma?
can it be prevented?
what are treatment options?

1. Dr Zain Ul Abidin Bahawal Victoria Hospital Bahawalpur [email protected] ASTHMA

2. Definition It is a disease characterized by recurrent attacks of breathlessness and wheezing , which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day.

3. Causes AHR : airway hyper-reactivity is the main cause of asthma Airway hyper reactivity Exaggerated response of the airways for a stimulus which triggers little or no response in normal people

4. Other Contributing Factors 1 .allergan exposure 2 .dietary deficiency of antioxidants 3.aspirin ( lipoxigenase pathway is intact) 4.other drugs(OCP, cholinergic drugs,B blockers) 5.exercise (non humidified inhaled air is a trigger)

5. Pathogenesis 3 basic characteristics identified are; A. airway hyper reactivity B. airway inflamation C. airway obstruction

6. Constricted airways in asthma

7. Types of asthma 1.extrinsic (atopic) 2.Intrinsic or adult onset (can be atopic or non atopic) 3.exercise induced 4.child onset (atopic) 5.Occupational 6.aspirin induced( lipoxigenase pathway causes bronchoconstriction ) 7.nocturnal 8.pregnancy

8. Clinical presentation The patient will be presenting the following symptoms RECURRENT EPISODES OF Breathlessnes Wheezing Chest tightness Cough (may be the only presentation)

9. Diurnal pattern Characteristically there is a diurnal pattern . Symptoms worsen in the early morning

10. Nocturnal asthma If the condition is not properly managed ,there would be nocturnal asthma Cough and wheezing disturbing sleep

11. DIAGNOSIS

12. Diagnosis Mostly clinical diagnosis Symptoms. Recurrent Episodes of breathlessness Coughing Wheezing Chest tightness

13. Signs of asthma Signs Rapid shallow breathing Pallor or cyanosis due to obstruction Hyperexpansion of the chest Tachycardia for the compensation Tachypnea Frequent pausing to catch breath while talking

14. Investigations Routine pulmonary function test Normal or signs of obstruction Dispropotionately Decreased FEV /FVC + hyperinflation(inc VC) and improvement with bronchodilators

15. Spirometry

16. Investigations Chest X-ray Normal in asymptomatic patients Hyperinflation in symptomatic patients

17. Hyperinflation of lungs

18. Investigations Peak Flow Measurements Diurnal variation in PEF of more than 20% is considered diagnostic

19. Investigations Skin Tests to establish atopy

20. Investigations Blood tests Eosinophila and increased IgE levels in atopy

21. Management

22. Management(stepwise approach) Step One . For patients with mild intermittent asthma _symptoms less than once a week for 3 mnths _less than 2 nocturnal episodes Occasional inhalational use of short acting B adrenoreceptor agonists Eg salbutamol or terbatuline

23. Management Step Two .introduction of regular preventor therapy.. Inhaled B agonists + Inhaled corticosteroids ( eg beclomethasone ) In patients with _ exacebration of asthma in last 2 yrs _uses B agonist inhaler 3 times a week or more _reports symptoms three times a week or more _presentation of nocturnal asthma

24. Management Step 3. add on therapy For patients who are not controlled even by ICS. Long acting B agonists are added eg salmeterol,formoterol . Inhaled B agonists + Inhaled corticosteroids + Long acting B agonists

25. Management Step Four. Addition of a 4 th drug (if step 3 is not effective) Nasal corticosteroids are added Inhaled B agonists + Inhaled corticosteroids + Long acting B agonists + nasal corticosteroids Step Five. Continuous or frequent use of oral Steroids Prednisolone therapy is prescribed at the lowest amount to control symptoms

26. Management Step Down Therapy Once asthma control is established,the dose of ICS should be titrated. Decreasing the dose by 25-50% every 3 months is the reasonable strategy for most patients

27. Management of acute severe asthma Acute severe asthma PEF 33-50% Respiratory rate 25/min or more Heart rate 110/min or more Inability to complete sentence in 1 breathe Management 1.Oxygen at high concentration (humidified if possible) 2.High doses of Inhaled bronchodilators (via nebulizer) 3.Systemic corticosteroids 4.Intravenous fluids

28. Oxygen therapy