Bronchial asthma

POWERPOINT PRESENTATION ON BRONCHIAL ASTHMA FOR THE MEDICAL STUDENTS

1. BRONCHIAL ASTHMA

2. Introduction Asthma derived from Greek word ásthma which means to stay awake in order to breath or difficulty in breathing. Asthma is a chronic inflammatory disease in which patient suffers with reversible episodes of airway obstruction and bronchospasm.

3. EPIDEMIOLOGY Asthma is one of the most common chronic diseases worldwide —1600 millions patients suffered from asthma An overall increase in severity of asthma increases the pool of patients at risk for death. As per WHO, India has 30 million asthmatics which is 10% of the global asthmatic population The prevalence of asthma is higher in children. Today, up to 1 out of 10 children in India has asthma. As per a study, Asthma in children has doubled over the past 5 years and is rapidly increasing. There will be an additional 100million asthmatics worldwide by 2025

4. ASTHMA TRIGGERS Allergens Air Pollutants Respiratory infections Exercise and hyperventilation Weather changes Gases like Sulfur dioxide Food, additives, drugs

5. RISK FACTORS THAT LEAD TO ASTHMA DEVELOPMENT Host Factors Genetic predisposition Airway hyper- responsiveness Gender Race Environmental Factors Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air Pollution Respiratory Infections Parasitic infections Socioeconomic factors Family size Diet and drugs Obesity

6. Early phase (Acute) - Due to bronchial smooth muscle spasm. - Excessive secretion of mucus. Chronic phase Continuous Inflammation, fibrosis, oedema, necrosis of bronchial epithelial cells. It has 2 phases-

7. SYMPTOMS Common symptoms of asthma include: Coughing Wheezing Tightness in the chest Shortness of breath Symptoms are worsening at night

8. Common symptoms of asthma   Coughing, especially at night Wheezing Shortness of breath Chest tightness, pain, or pressure SIGNS AND SYMPTOMS

9. Mild asthma attack Cough Wheezing Mild difficulty breathing during normal activities Difficulty sleeping Hiccups Peak expiratory flow rate (PEFR) is 70 to 90% of personal best  Symptoms of asthma attack

10. Moderate asthma attack Severe cough Moderate wheezing Shortness of breath Chest tightness Usually worsens with exercise Inability to sleep Nasal congestion PEFR is 50 to 70% of personal best 

11. Severe asthma attack Severe wheezing Severe difficulty breathing Inability to speak in complete sentences Sentences are interrupted by breathing Inability to lie down Signs of severe difficulty breathing Rib retractions: ribs are visible during each breath  Nasal flaring: nostrils open wide during each breath  Use of accessory muscles: neck muscles are prominent during each breath  Chest pain Sharp, chest pain when taking a breath, coughing PEFR is <50% of personal best  Confusion Rapid pulse Fatigue Rapid breathing rate

12. CAUSES While the exact cause of asthma is not known, it is thought that a variety of factors interacting with one another, early in life, result in the development of asthma. Parents with asthma Atopy Childhood respiratory infections Exposure to allergens or infections while the immune system is developing

13. PATHOPHYSIOLOGY Allergen enter (Foreign body) Immunological reaction (AG:AB Complex formation ) Circulation in blood Basophiles, Neutrophills engulf Cause neutralization

14. Whenever same allergens are exposed Activation of AG:AB complex Reacts with lung mast cells ( Degranulation of mast cells ) Spasmogens release ( Like Histamine,5HT,PGs,LT 4, Cytokines ) Cause inflammation, oedema , bronchospasm, muscus secretion, epithelial damage

15. PATHOLOGY

16. Initial exam (conducted by doctor): Medical history Asthma symptoms, how you feel, known asthma and allergy triggers, your activity level and diet, your home and work environment, and family history.   Then, some tests will be conducted to diagnose asthma DIAGNOSIS & TESTS

17. DIAGNOSING ASTHMA: Medical History Symptoms Coughing Wheezing Shortness of breath Chest tightness Symptom Patterns Severity Family History

18. Diagnosing Asthma Troublesome cough, particularly at night Awakened by coughing Coughing or wheezing after physical activity Breathing problems during particular seasons Coughing, wheezing, or chest tightness after allergen exposure Colds that last more than 10 days Relief when medication is used

19. PEAK FLOW TESTING Peak Flow Meter PEFR is used to assess the severity of wheezing in those who have asthma. PEFR measures how quickly a person can exhale air from the lungs Peak expiratory flow rate (PEFR)

20. Diagnosing Asthma: SPIROMETRY Test lung function when diagnosing asthma

21. It measures how much air you can exhale. FEV1(force expiratory volume) > 80% = normal Confirms the presence of airway obstruction and measure the degree of lung function impairment. Monitor your response to asthma medications SPIROMETRY (LUNG FUNCTION TEST)

22. A drop of liquid containing the allergen in placed on your skin (generally forearms is used). A small lance with a pinpoint is poked through the liquid into the top layer of skin ( prick test). If you are allergic to the allergen, after about 2 minutes the skin begins to form a reaction (red, slightly swollen, and itchy: it makes a hive). The size of the hive is measured and recorded. The larger the hive, the more likely it is that you are allergic to the allergen tested. ALLERGY-SKIN TEST

23. Allergy-skin test

24. If there are symptoms that may be caused by another condition such as pneumonia, your doctor may want to do a chest X-ray. It also may help to clarify the problem if there is problem with asthma treatment. CHEST X-RAY

25. TREATMENT While asthma cannot be cured, it can be controlled: Medications Long term Quick relief Bronchial thermoplasty ( therapeutic radiofrequency energy to the airway wall, thus heating the tissue and reducing the amount of smooth muscle present in the airway wall.) Learning to recognize one’s own triggers and taking steps to avoid them.

26. Treatment (cont..) Medication Long term: Taken daily over a long period of time Used to reduce inflammation, relax airway muscles, and improve symptoms and lung function Inhaled corticosteroid Leukotriene modifiers Long-acting beta agonists Combination inhalers

27. Treatment (cont..) Quick-Relief: Used in acute episodes Generally short-acting beta 2 agonists

28. Allergic asthma (extrinsic) Non-allergic asthma (intrinsic) Cough variant asthma Occupational asthma Exercise induced asthma Medication induced asthma Nocturnal asthma TYPES OF ASTHMA

29. It is triggered when you inhale one of the following allergens: Tobacco smoke Animal dander Dust mites Cockroaches Molds Pollens Age onset over 40 y/o Specific symptoms : Runny nose, watery eyes, you are wheezing more, swollen nasal passages, excess mucus, and a scratchy throat. A cough may result from the constant postnasal drip ALLERGIC ASTHMA (EXTRINSIC)

30. Not triggered by allergens Age onset under 40 y/o Triggers: Irritants- Tobacco smoke, wood smoke, room deodorizers, fresh paint, household cleaning products, cooking odours, workplace chemicals, perfumes, and outdoor air pollution, heartburn, changes in temperature. Specific symptoms: Respiratory infections, such as the common cold, Influenza or a sinus infection. NON-ALLERGIC ASTHMA (INTRINSIC)

31. When cough is the only asthma symptom, this is known as cough variant asthma (CVA) Specific symptoms: Chronic, non- productive cough High sensitive cough reflex COUGH VARIANT ASTHMA

32. A common respiratory condition that results from exposures in the workplace Examples of the occupations and the potential irritants include: Dental hygienists: latex Bakers: flour Roofers, insulators and painters: isocyanates (toluene) Welders and metal workers: metals: metals (nickel, platinum and chromic acid) Plastic manufacturers: glues and resins Farmers and veterinarians: animal proteins Carpenters: wood dust OCCUPATIONAL ASTHMA

33. Specific symptoms: Airway irritation, obstruction, and inflammation. Worsening after arriving at work and improvement on weekends or during extended periods away from work. Treatment : Engineering controls (such as improved ventilation) to reduce or eliminate the substance Use respiratory protective equipment Cont…

34. A type of asthma triggered by exercise or physical exertion Specific symptoms: SOB , chest tightness, and cough. Symptoms may occur shortly after a brief episode of exercise or 10 to 15 minutes into a longer period of exercise. Exercise induced asthma

35.  The asthma getting worse because of medication you take for another health condition. Causes: Anti- inflammatories for aches and pain: Motrin, Advil Heart disease drugs : inderal , coreg (beta-blockers) Glaucoma drugs: beta-blockers eyes drop Hypertension and congestive heart failure drugs: angotensive converting enzyme inhibitors (ACE) Medication induced asthma

36. The chances of having asthma symptoms are much higher during sleep because asthma is powerfully influenced by the sleep-wake cycle (circadian rhythms) Causes : Exposure to allergens, cooling of the airways, reclining position, hormone secretions that follow a circadian pattern, heartburn at night  Specific symptoms:  wheezing, cough, and trouble breathing are common and dangerous, particularly at night time. Nocturnal(night time) asthma

37. Medications to Treat Asthma: How to Use a Spray Inhaler

38. Medications to Treat Asthma: Nebulizer Machine produces a mist of the medication Used for small children or for severe asthma episodes No evidence that it is more effective than an inhaler used with a spacer