Asthma.Chromic obstructive pulmonary disease

Cpg guidelines

1. Bronchial Asthma
A heterogeneous disease, usually characterized by chronic airway
inflammation. It is defined by the history of respiratory symptoms such
as wheeze, shortness of breath, chest tightness and cough that vary over
time and in intensity, together with variable expiratory airflow
limitation.

2. Symptoms of Asthma
1Shortness of Breath
Experiencing difficulty breathing and a
tight feeling in the chest.
2Coughing and Wheezing
Produces a wheezing or whistling sound
when breathing.
3Chest Tightness
Feeling pressure or a squeezing sensation
in the chest.
4Difficulty Sleeping
Struggling to sleep due to coughing or
shortness of breath.

3. Risk Factors of Asthma
1Genetics 2Environmental
Smoking, Air pollution, Pesticides
3Other Co-morbidities
Overweight/obese, GERD, allergic rhinitis

4. Pathophysiology of Asthma
Type I hypersensitivity
Allergen → activate T helper cells → stimulate B cells → Produce IgE → degranulation of mast cells→
release of histamine → inflammation→ bronchoconstriction→ Raised eosinophils → goblet cells
hyperplasia → increase mucous secretions

5. Diagnosis of Asthma
History
Symptoms, symptom
variability, triggers, history
of atopy
Physical Examination
Eczema, Audible wheeze,
use of accessory muscles ,
rhonchi on auscultation
Spirometry
A FEV1 (forced expiratory
volume in 1 second)/FVC
(forced vital capacity) ratio
of <70% is a positive test for
obstructive airway disease

6. History Taking
❖Assesment of symptoms
1)Dyspnoea – progressive, persistent, gradually interferes with daily activities
2)Cough – initially intermittent, then daily with chronic sputum production
3)Wheezing and chest tightness
❖History
1)Smoking
2)Occupational and environmental exposure to lung irritants
3)Family hx : COPD/ other chronic respiratory disorders
4)Past medical history - asthma, respiratory infections in childhood
5)History of exacerbations or previous hospitalizations for respiratory disorder.
6)Comorbidities, such as heart disease.
7)Impact of disease on patient’s life, including limitation of activity

7. Differential Diagnosis of Asthma
COPD
Onset in midlife
Symptoms developed
prgressive
History of exposure to
smoke
Bronchiectasis
Purulent sputum
Commonly seen in
bacterial infection
Bronchial
dilation/bronchial wall
thickening on cxr
Asthma
Early onset
Symptoms vary from day
today
Night/Early morning
Allergy/rhinitis/eczeema
TB
All ages
Lung infiltration on cxr
Congestive heart failure
Dilated heart
Pulmonary edema

8. Stable Asthma

10. Types of Inhaler
SABA
Short-acting β2-agonists
Immediate symptom reliever in asthma,
regular use of SABA alone without ICS
worsens lung function significantly and
increases airway inflammation in asthma
Combined low dose ICS/LABA
Combined low dose inhaled
corticosteroids/long-acting β2- agonists
Combined low dose ICS/LABA as a single
inhaler for maintenance and reliever therapy
significantly reduces severe exacerbations in
moderate to severe asthma compared with
fixed dose ICS/LABA. [budesonide/formoterol
and beclometasone/formoterol]
Rapid-onset LABA
Long-acting β2-agonist
Formoterol is as effective as SABA as a reliever
medication in asthma, but its use without ICS
is strongly discouraged because of the risk of
fatal and non-fatal adverse events.

11. Non Pharmacological Treatment of Asthma
Quit smoking
Weight loss
Vaccination
Caffeine
Breathing exercise

12. Acute Exacerbation of Asthma

14. Chronic Obstructive
Pulmonary Disease
A heterogeneous lung condition characterized by chronic respiratory
symptoms (dyspnea, cough, expectoration and/or exacerbations) due to
abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli
(emphysema) that cause persistent, often progressive, airflow
obstruction.

15. Pathophysiology of COPD

16. GOLD-Severity

17. MMRC-Symptoms

18. CAT-Assessment Score
scores < 25 are uncommon in diagnosed COPD patients(93) and scores ≥ 25 are very uncommon in
healthy persons

19. COAD Assessment

20. Management

21. Non Pharmacological Treatment for COPD

22. Acute Exacerbation of COPD

24. Mainstay of Treatment
High Flow Mask Non Invasive Mechanical
Ventilation
Respiratory acidosis:
PaCO2 >45mmHg and
pH<7.35
Severe dyspnea with
clinical signs of
exhaustion
Persistent hypoxemia
Invasive Mechanical
Ventilation
Failed NIV
Collapse
Altered mental status
Hemodynamically
unstable
Severe ventricular or
supraventricular
arrhythmia

25. References
https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/CPG%20Management%2
0of%20Asthma%20in%20Adults.pdf
​https://goldcopd.org/wp-content/uploads/2023/03/GOLD-2023-ver-1.3-17Feb2023_WMV.pdf