BRONCHIAL-ASTHMA-POWER POINT PRESENTATION

bronchial asthma is an upper respiratory tract infection

1. BRONCHIAL ASTHMA
MWANAMISI BAKARIMWANAMISI BAKARI
BSCNBSCN

2. Definition
Asthma is a chronic inflammatory disease of the
airways which develops under the allergens influence,
associates with bronchial hyperresponsiveness and
reversible obstruction and manifests with attacks of
dyspnea, breathlessness, cough, wheezing, chest
tightness and sibilant rales more expressed at breathing-
out.

3. Epidemiology
According to epidemiological studies asthma affects
1-18% of population of different countries.
Only in 2006 more than 300 million patients
suffered from asthma all over the world, 250 thousands of
patients die of asthma. The incidence of asthma is higher
in countries with increased air pollution.

4. causes
Allergic reactions to plants, foreign
bodies in the air way.

5. Etiology
The allergens
are divided into:
•Communal,
•Industrial,
•Occupational,
•Natural
•Pharmacological

6. Сommunal allergens are contained in the air of
apartment houses. They are:
House-dust mites which live in carpets mattresses
and upholstered furniture;
Vital products of domestic insects (e.g., cockroach);
Tobacco smoke during active or passive smoking;
Various communal aerosols and synthetic
detergents.

7. Among the industrial allergens nitric, carbonic, sulfuric
oxides, formaldehyde, ozone and emissions of
biotechnological industry - main components of industrial
and photochemical.
The most important occupational allergens are dust of stock
buildings, mills , weaving-mills, book depositories etc.
Natural allergens are represented by plant pollen (especially
ambrosia, wormwood and goose-foot pollen) and different
respiratory, particularly viral, infections.

8. Some allergens which may cause asthma
House-dust mites which live in
carpets, mattresses and
upholstered furniture
Spittle, excrements,
hair and fur
of domestic
animals
Plant pollen
Pharmacological
agents (enzymes,
antibiotics,
vaccines, serums)
Food
components
(stabilizers,
genetically
modified products)
Dust of
book
depo-
sitories

9. Asthma Triggers
©2010

10. Trigger-factors, which provoke
bronchospasm, are: a simultaneous penetration of a
large quantity of allergen, viral respiratory infection,
hyperventilation, physical exertion, emotional
stress, becoming too cold, adverse weather
conditions, administration of some medicines
(aspirin, -blockers).

11. Pathophysiology
Asthma pathophysiology is quite
difficult and insufficiently studied. Undoubtedly,
in most cases the disease is based on 1 type
hypersensitivity reaction. The genesis of any
allergic reaction may be divided into immune,
pathochemical and pathophysio-logic phases.

12. Classifications of Asthma
1. Spasmodic: sporadic in nature with varying
intervals of free and difficulty due to precipitating
factors often readily defined.
2. Continuous: some shortness of breath on
occasion, transit wheezing on strenuous exercise
and wheezy rales hard deep inspiration.

13. Classifications of Asthma cont…
3. Intractable: persistent wheezing requiring
regular daily medication for either control of
symptoms or ability to function.
4. Status Asthmaticus: sever attach in which
patient deteriorates in spite of adequate
treatment.

15. Clinical manifestations
Classic signs and symptoms of asthma are:
Attacks of expiratory dyspnea
Shortness of breath
Cough.
Chest tightness
Wheezing (high-pitched whistling sounds when
breathing out)
Sibilant rales

16. In typical cases in development of asthma
exacerbation there are 3 periods – prodromal period,
the height period and the period of reverse changes.
At the prodromal period:
vasomotoric nasal reaction with profuse watery
discharge,
sneezing, dryness in nasopharynx,
paroxysmal cough with viscous sputum,
emotional lability,
excessive sweating,
skin itch and other symptoms may occur.

17. At the peack of exacerbation there are:
expiratory dyspnea
forced position with supporting on arms
poorly productive cough
cyanotic skin and mucous tunics
hyperexpansion of thorax with use of all accessory muscles
during breathing
at lung percussion: tympanitis, shifted downward lung borders
at auscultation: diminished breath sounds, sibilant rales,
prolonged breathing-out, tachycardia.
in severe exacerbations: the signs of right-sided heart failure
(swollen neck veins, hepatomegalia), overload of right heart
chambers on ECG.

18. At the period of the reverse changes,
Which comes spontaneously or under
pharmacologic therapy.
Dyspnea and breathlessness relieve or
disappear.
Sputum becomes not so viscous.
Cough turns to be productive.
Patient breathes easier.

19. Asthmatic status
The severe and prolonged asthma exacerbation with intensive
progressive respiratory failure, hypoxemia, hypercapnia,
respiratory acidosis, increased blood viscosity and the most
important sign is blockade of bronchial 2-receptors.
Stages:
1
st
- refractory response to 2-agonists (relaxation of the smooth muscles)
2
nd
- “silent” lung because of severe bronchial obstruction and
collapse of small and intermediate bronchi;
3
rd
stage – the hypercapnic coma.

20. In many cases asthma, particularly intermittent,
manifests with few and atypical signs:
episodic appearance of wheezing;
cough, heavy breathing occurring at night;
cough, hoarseness after physical activity;
“seasonal” cough, wheezing, chest tightness
the same symptoms occurring during contact with
allergens, irritants;
lingering course of acute respiratory infections.

21. Diagnosis
Typical clinical
manifestations
and lung
function
assessment are
sufficient for
diagnosis of
asthma.

22. Management
1. Avoiding the contact with allergen. If it is impossible, the
specific hyposensitization with standard allergens should
be performed. It is rather effective in case of monoallergy, in
intermittent and mild persistent asthma, in remission phase.
2. Elimination of trigger factors (rational job placement,
changing the residence, psychological and physical
adaptation, careful drug using) is the second condition for
successful asthma treatment.
3. Optimally selected medical care is the base of asthma
management.

23. Combined inhaled drugs (corticosteroids with
2-agonists) (nebulasers, turbuhalers, spasers,
spinhalers, sinchroners) enhance the
effectiveness of asthma therapy.

24. Management of
asthmatic status
Oxygen
Systemic corticosteroids (Hydrocortisone 200mg or Prednisolone 50
mg/day per)
Inhalations of short-acting 2-agonists - Salbutamol 5mg or
Fenoterol 2mg through nebulaser – 3 times at 1
st
hour, then once
an hour till distinct improvement of patient’s condition is achieved;
then 3-4 times a day.
Inhaled anticholinergic drugs or Aminophylline IV.
If ineffective - artificial lung ventilation.

25. Prognosis
In case of early detection and adequate
treatment the prognosis for the disease is
favourable.
It becomes serious in severe persistent and
poorly controlled (insensitive for
corticosteroids) asthma.

26. The examination of working capacity
The patients with unfavorable for the
disease conditions of work need the job
replacement.
Physical labours with severe asthma are
disable to work.

27. Prophylaxis
Preservation of the environment, healthy
life-style (smoking cessation, physical
training) – are the basis of primary asthma
prophylaxis. These measures in combination
with adequate drug therapy are effective for
secondary prophylaxis.