Guidelines for asthma management | Jindal Chest Clinic

Presentation on "Guidelines for asthma management" by Dr. S.K
Jindal.

1. S. K. Jindal
www.jindalchest.com

2. Wrong Diagnosis
•ChronicObstructivePulmonaryDisease
•Cardiacasthma
•Upperairwayobstruction
•Vocalcorddysfunction
•Sleepapnoea
•Localobstructionbytumours/foreignbody
•Hypersensitivitypneumonias
•Infections/Bronchiectasis
•Pulmonaryembolism

3. All that wheezes is
“Not Asthma”
and
All asthma
does not wheeze

5. Casesummary
40M,shopowner
Presentingcomplaints
Recurrentepisodesof‘apnea’:10months
Background
•Frequentcough
•OccasionalBreathlessnessfor10years
•Nodefiniteh/owheeze
•h/oloudsnoring,nodaytimesomnolence
•Noh/oseizures,abnormalbehavior
•Noh/ostridor(butdocumentedinPGI)
[J Assoc Physicians India 2001; 49:488-90]

6. Current Illness: Nov 1999: First episode at night
Uneasiness and difficulty in breathing
Impaired consciousness
Blue
Admitted to ER, intubated,
Recovered with in a day
Subsequently Five admissions to DMC
~ 10 episodes requiring ETT and short term mechanical ventilation
(few hours to 1 day)
Normal in between the episodes

7. Noresponsetoantiasthmameasures
Veryquickreversalonintubation
Normallungfunctionsinbetween
Documentedstridor
VOCAL CORD DYSDFUNCTION

8. Normal VC VCD VCD Post treatment

9. Disease Association
•Rhino-sinusitis/Polyps
•G.E.Reflux
•Obstructivesleepapnoea
•COPD
•Allergicbronchopulmonaryaspergillosis
•Otherinfections
•Churg-Strausssyndrome/vasculitides
•Psychologicalproblems

10. SS31MFarmer
•H/obreathlessness,wheezing(episodic)
mucoid/mucopurulentsputum>10yrs
•Acutesevereattacks
•Poorresponsetoasthmatmt.
•H/oATTinthepast(twice)
•Exam:Extensiverhonchi&crackles
•Haemogram:TLC12000/cum.E8%

11. Allergic Broncho Pulmonary Aspergillosis
•Skintest:Immediate&delayed+ve
•Sputumforaspergillus+ve
•Serology+ve
•TreatedwithoralCS
•Antifungaltmt?
•Maintenancetmt?

12. Morphological
•Structural continuity
•Common passage
•Similar/same exposures, insults & Inflammatory responses