ASTHMA, is a conition of lower respiratory tract

Asthma is an allergic reaction of airway

1. Conditions of the lower
respiratory tract.
BY:
MUTEGEKI ADOLF

2. 1. Asthma
Definition:Asthma is a chronic inflammatory disorder of the airways
characterized by episodes of reversible airway obstruction, bronchial hyper-
responsiveness, and airway inflammation. This leads to recurrent episodes
of wheezing, breathlessness, chest tightness, and coughing, particularly at
night or in the early morning
Aetiology: Asthma's exact cause is not fully understood, but it is believed to
result from a combination of genetic and environmental factors.
Key contributors include:
a)Genetic Predisposition:
•Family history of asthma or atopy(allergic conditions like eczema, allergic rhinitis).
•Specific genetic variants associated with immune response and airway function.

3. b) Environmental Factors:
•Allergens:House dust mites, pollen, mold, pet dander, and cockroach
droppings.
•Irritants:Tobacco smoke, air pollution, strong odors, and chemical fumes.
•Infections:Respiratory viral infections, particularly in early childhood.
•Occupational Exposures:Certain chemicals, dusts, and gases in the workplace.
•Dietary Factors:Obesity and a diet low in antioxidants may increase risk.
C) Other Contributing Factors:
•Exercise, particularly in cold air.
•Emotional stress.
•Gastroesophagealreflux disease (GERD).

4. Pathophysiology
•Asthma involves complex interactions between airway inflammation,
intermittent airflow obstruction, and bronchial hyperresponsiveness:
a) Airway Inflammation
•Inflammatory cells, including eosinophils, mast cells, T lymphocytes, and neutrophils,
infiltrate the airway walls.
•Release of inflammatory mediators such as histamine, leukotrienes, and cytokines leads
to airway edema and mucus hypersecretion.
b) Airflow Obstruction
•Bronchoconstriction due to smooth muscle contraction.
•Airway edema and mucus plug formation further narrow the airways.
•This obstruction is typically reversible, either spontaneously or with treatment.
c) Bronchial Hyperresponsiveness
•Increased sensitivity of the airways to various stimuli, leading to exaggerated
bronchoconstriction.
•Chronic inflammation results in structural changes (airway remodeling), including
thickening of the basement membrane and increased smooth muscle mass, which may
contribute to persistent airflow limitation.

7. Clinical Presentations
Asthma symptoms vary widely in frequency and severity.
•Wheezing:A high-pitched whistling sound, particularly during
expiration.
•Shortness of Breath:Often worsens with physical activity, at night, or
early in the morning.
•Chest Tightness:A sensation of pressure or constriction in the chest.
•Coughing:Typically dry, persistent, and may worsen at night or early
morning.
•Increased Respiratory Rate and Use of Accessory Muscles:During an
asthma attack.
•Note:Symptoms are often episodic, with symptom-free periods
between attacks. However, in severe cases, symptoms may persist
and lead to chronic breathlessness.

8. Differential diagnosis
•Heart failure
•Other causes of chronic cough
•Bronchiolitis
•Bronchiectasis

9. Investigations
•Spirometry:
•Measures lung function, including FEV1 (forced expiratory volume in one second) and FVC
(forced vital capacity).
•A reduced FEV1/FVC ratio that improves after bronchodilator administration suggests reversible
airway obstruction.
•Peak Expiratory Flow (PEF):
•Simple tool for monitoring asthma control. Variability in PEF readings indicates poor control.
•BronchoprovocationTests:
•Methacholineor exercise challenge tests to assess airway hyperresponsiveness.
•Allergy Testing:
•Skin prick tests or serum IgElevels to identify specific allergens.
•Chest X-ray:
•Typically normal in asthma but can rule out other causes of symptoms (e.g., pneumonia,
pneumothorax).
•Blood Tests:
•CBC mostly for Eosinophil count
•Serum IgElevels may be elevated in atopic asthma.

10. Management
General principles of management
•The four essential components of Asthma Management:
a)Patient education
b)Control of asthma triggers
c)Monitoring for changes in symptoms or lung function and
d)Pharmacologic therapy.
•Inhalation route is always preferred as it delivers the medicines
directly to the airways; the dose required is smaller, the side-effects
are reduced
•Egnebulisersolutions for acute severe asthma are given over 5-10
minutes, usually driven by oxygen in hospital

11. •Parenteral route is used only in very severe cases when
nebulisationis not adequate.
•Acute Asthma
•Asthma attack is a substantial worsening of asthma
symptoms. The severity and duration of attacks are variable
and unpredictable. Most attacks are triggered by viral
infections.
•Not all features may be present. If the patient says they feel
very unwell, listen to them!

12. Assessment of Severity
Mild to moderate
•Able to talk
•Pulse < 110 bpm
•Respiratory rate < 25
•Peak flow >50% of predicted
or best SpO2 ≥ 92%
Severe
•Cannot complete sentences
in one breath
•Pulse 110 bpm
•Respiratory rate >25
•Peak flow <50% of predicted
or best SpO2 ≥ 92%

13. Life threatening (Adults and Children)
•Silent chest, feeble respiratory effort, cyanosis
•Hypotension, bradycardia or exhaustion,
agitation
•Reduced level of consciousness
•Peak flow < 33% of predicted or best Arterial
oxygen saturation < 92%

14. Management of asthma attacks
A. Mild to moderate
•Treat as an out-patient
•Reassure patient; place him in a ½ sitting position
•Give salbutamol Inhaler 2-10 puffs via a large volume spacer, Or 5
mg (2.5 mg in children) nebulisation
•Repeat every 20-30 min if necessary
•Prednisolone 50 mg (1 mg/kg for children)
•Monitor response for 30-60 min. If not improving or relapse in 3-4
hours Refer to higher level

15. •If improving, send home with
•Prednisolone 50 mg (1 mg/kg for children) once a day for 5
days (3 days for children)
•Institute or step up chronic treatment
•Follow up after 1-2 weeks
•Instruct the patients on self-treatment and when to come
back
•Review in 48 hours
•Do not give routine antibiotics unless there are clear signs
of bacterial infection

16. B. Severe Attack
•Patients with severe asthma need to be referred to HC4 or
hospital after initial treatment.
•Admit patient; place him in a ½ sitting position
•Give high flow oxygen continuously, at least 5 litres/minute,
to maintain the SpO2 ≥ 94% if available
•Give salbutamol Inhaler 2-10 puffs via a large volume spacer,
Or 5 mg (2.5 mg in children) nebulization. Repeat every 20-
30 min if necessary during the 1
st
hour

17. •Prednisolone 50 mg or f Or hydrocortisone 100 mg (children 4 mg/kg max 100
mg) IV every 6 hours until patient can take oral prednisolone
•Monitor response after nebulisation
•If response poor, pratropiumbromide nebuliser500 micrograms every 20-30
min for the first 2 hours then every 4-6 hours
•Or Aminophylline 250 mg slow IV bolus if patient is not taking an oral
theophylline
•Alternatively, if symptoms have improved, respiration and pulse settling, and
peak flow >50%
•Step up the usual treatment and continue with prednisolone to complete 5
days of treatment
•Review within 24 hours
•-Monitor symptoms and peak flow
•Arrange self-management plan

18. Life threatening
•Arrange for immediate hospital referral and admission
First aid
•Admit patient; place him in a ½ sitting position
•Give high flow oxygen continuously, at least 5 litres/minute, to
maintain the SpO2 ≥ 94% if available
•Give salbutamol Inhaler 2-10 puffs via a large volume spacer Or 5
nebulisation
•Repeat every 20 min for 1 hour

19. •Hydrocortisone 100 mg IV stat or prednisolone 50 mg
•Ipratropium bromide nebuliser500 micrograms every 20-
30 minutes for the first 2 hours then every 4-6 hours
•Monitor response for 15-30 minutes
•If response is poor, Give Aminophylline 250 mg slow IV
bolus If patient is not taking an oral theophylline
Note: The use of aminophylline and theophylline in the
management of asthma exacerbations is discouraged
because of their poor efficacy and poor safety profile

20. Chronic Asthma
•General principles of management
•Follow a stepped approach Before initiating a new drug,
check that diagnosis is correct, compliance and inhaler
technique are correct and eliminate trigger factors for acute
exacerbations.
•Start at the step most appropriate to initial severity Rescue
course
•Give a 3-5 days “rescue course” of prednisolone at any step
and at any time as required to control acute exacerbations of
asthma at a dose of 40-60 mg daily for up to 3-5 days.

21. Stepping down
•Review treatment every 3-6 months
•If control is achieved, stepwise reduction may be possible
•If treatment started recently at Step 4 (or contained
corticosteroid tablets, reduction may take place after a
short interval;
•In other patients 1-3 months or longer of stability may be
needed before stepwise reduction can be done

22. STEP 1: Intermittent asthma
•Intermittent symptoms (< once/week)
•Night time symptoms < twice/month
•Normal physical activity
•Occasional relief bronchodilator: Inhaled short-acting
beta2 agonist e.g. salbutamol inhaler, 1-2 puffs (100-200
micrograms)
•Move to Step 2 if use of salbutamol needed more than
twice a week or if there are night-time symptoms at least
once a week.

23. STEP 2: Mild persistent asthma
•Symptoms > once/week, but < once/day
•Night time symptoms > twice/month
•Symptoms may affect activity
Regular inhaled preventer therapy
•Salbutamol inhaler 1-2 puffs prn
•Plus regular standard-dose inhaled corticosteroid, e.g.
beclomethasone 100-400 micrograms every 12 hours.
•Assess after 1 month and adjust the dose prn
•Higher dose may be needed initially to gain control
•Doubling of the regular dose may be useful to cover exacerbations

24. •STEP 3: Moderate persistent asthma
•Daily symptoms
•Symptoms affect activity
•Night time symptoms > once/week
Daily use of salbutamolSalbutamolinhaler 1-2 puffs
prn up to 2-3 hourly Usually 4-12 hourly
•PLUS beclomethasoneinhaler 400-1000 micrograms
every 12 hours
•In adults, also consider 6-week trial with
Aminophylline 200 mg every 12 hours

25. STEP 4: Severe persistent asthma
•Daily symptoms
•Frequent night time symptoms
•Daily use of salbutamol
Regular corticosteroid tablets plus Regular high-dose
beclomethasone(as in Step 3)
•Plus regular prednisolone 10-20 mg daily after breakfast
Note:If inhaler not available, consider salbutamol tablets 4
mg every 8 hours

26. Prevention
•Primary Prevention:
•Avoid exposure to tobacco smoke and environmental pollutants during pregnancy
and early childhood.
•Breastfeeding may reduce the risk of developing asthma.
•Secondary Prevention:
•Early identification and treatment of allergic conditions.
•Avoidance of known triggers in sensitized individuals.
•Regular use of controller medications to maintain control and prevent exacerbations.
•Tertiary Prevention:
•Educating patients on early recognition of worsening symptoms and adherence to
treatment.
•Regular follow-up with healthcare providers to monitor asthma control and adjust
treatment as needed.

27. THANKS
FOR
LISTENING