ASTHMA.pptx by Mokuru Davies(Medicine and Surgery student)

Asthma

1. ASTHMA Mokuru Davies MBChB V

2. Definition Pathophysiology Clinical presentation Diagnosis Management

3. Definition Heterogeneous disease characterized by chronic airflow inflammation intermittent expiratory airflow limitation bronchial hyper responsiveness

4. Pathophysiology

5. Diagnosis History Pattern of respiratory symptom characteristic of asthma > 1 wheeze, SOB, cough, chest tightness/ pain worse at night/ early morning vary over time and in intensity Triggers RULE OUT OTHER DDX

6. Diagnosis Physical examination Tachypnea Signs of resp distress Signs of allergic rhinitis/ nasal polyposis Rhonchi, silent chest If chronic may have signs of cor pulmonale esp loud P2.

7. Diagnosis Spirometry Variable expiratory airflow limitation The grater the variations, the more confident the diagnosis Reduced FEV1/FVC ratio < 0.75 Positive bronchodilator reversibility test- increase FEV1≥ 12%/ > 200ml from baseline. Hold SABA/ LABA before test Significant increase in lung function after 4 weeks of anti inflammatory treatment

8. Pulmonary function tests

9. Diagnosis Sputum M icroscopy - Eosinophilic inflammation in allergic forms Allergy tests- serum Ig E and skin prick. Nonspecific CXR

10. Assessing risk factors Uncontrolled asthma Exposure to triggers Comorbidities Medication- non adherence, technique,SE Exposure to tobacco and noxious stimulus Pharmacotherapy Controllers- long term control Relievers- quick relief Others- SCS, MCSs

11. REVIEW RESPONSE ASSESS ADJUST * Off-label; data only with budesonide-formoterol (bud-form ) † Off-label; separate or combination ICS and SABA inhalers PREFERRED CONT R OLLER to prevent exacerbations and control symptoms Other controller options Other reliever option PREFERRED RELIEVER STEP 2 Daily low dose inhaled corticosteroid (ICS), or as-needed low dose ICS-formoterol * STEP 3 Low dose ICS-LABA STEP 4 Medium dose ICS-LABA Leukotriene receptor antagonist (LTRA), or low dose ICS taken whenever SABA taken † As-needed low dose ICS-formoterol * As-needed short-acting β 2 -agonist (SABA) Medium dose ICS, or low dose ICS+LTRA # High dose ICS, add-on tiotropium, or add-on LTRA # Add low dose OCS, but consider side-effects As-needed low dose ICS-formoterol ‡ Box 3-5A Adults & adolescents 12+ years Personalized asthma management: Assess, Adjust, Review response Asthma medication options: Adjust treatment up and down for individual patient needs STEP 5 High dose ICS-LABA Refer for phenotypic assessment ± add-on therapy, e.g.tiotropium, anti-IgE, anti-IL5/5R, anti-IL4R Symptoms Exacerbations Side-effects Lung function Patient satisfaction Confirmation of diagnosis if necessary Symptom control & modifiable risk factors (including lung function) Comorbidities Inhaler technique & adherence Patient goals Treatment of modifiable risk factors & comorbidities Non-pharmacological strategies Education & skills training Asthma medications 1 © Global Initiative for Asthma, www.ginasthma.org STEP 1 As-needed low dose ICS-formoterol * Low dose ICS taken whenever SABA is taken † ‡ Low-dose ICS-form is the reliever for patients prescribed bud-form or BDP-form maintenance and reliever therapy # Consider adding HDM SLIT for sensitized patients with allergic rhinitis and FEV >70% predicted

12. Add on Therapies Azithromycin In persistent symptomatic asthma despite moderate- high dose ICS LABA Reduced exacerbations and improved quality of life 2. Vitamin D Low serum vitamin D is associated with impaired lung function 3. Vaccinations I nfluenza - reduces exacerbations and is recommended in patients with moderate to severe asthma Pneumococcal vaccine recommended in children and elderly