Presentation on Treatment of Bronchial Asthma | Jindal Chest Clinic

Bronchial asthma is a lung disease characterized by inflammation, narrowing, swelling of airways, and increased mucus production, making it difficult to breathe. This Presentation gives an overview on "Treatment of Bronchial Asthma" including management, diagnosis, symptoms, Complications, etc. For more information, please contact us: 9779030507.

2. INFLAMMATION
Airflow Limitation
SYMPTOMS
Cough Wheeze
Dyspnoea
TRIGGERS
Allergens, Exercise,
Cold Air, SO2 Particulates
Airway
Hyperresponsiveness
Genetic*
INDUCERS
Allergens,Chemical sensitisers,
Air pollutants, Virus infections

3. 1.Symptom Treatment: Cough Wheeze, Dyspnoea
Treatment of Airflow Limitation
2. TREATMENT OF INFLAMMATION
3. Management of Airway Hyper-responsiveness
4. MANAGEMENT OF INDUCERS & TRIGGERS
Allergens, Chemical sensitizers, Virus infections
Air pollutants, Allergens, Exercise, Cold Air, SO2 Particulates
5. Genetic manipulation?

4. 1.Minimal (ideally no) symptoms
2.Minimal (or no) symptoms on exercise
3.Minimal need for relievers
4.No exacerbations
5.No limitation of physical activity
6.Normal (or near normal) PFT
7.Minimal side effects of drugs
8.Prevention of irreversible obstruction
9.Prevent asthma related mortality

5. Bronchodilators(Relievers)
Primaryactiononbronchialsmoothmuscles,relievebronchospasm,produce
symptomaticrelief
Anti-inflammatorydrugs(Controllers)
Reduceinflammation,improveairflow,reduceAHR,preventionofrecurrent
symptoms,prolongedrelief

7. 1.Theophyllines
2.Sympathomimetics
Betaagonists(Selective)
Rapidacting2agonists(Salbutamol,Terbutaline)
Longacting(Salmeterol,Formoterol)
Oralshortacting2agonists
3.Anticholinergic/muscarinicagents)
Inhaledanticholinergics
4.Oralglucocorticoids

8. Corticosteroids:
Inhaled(Beclomethasone,Budesonide,Fluticasone,Mometasone,
Triamcinalone)
Oral(Prednisone,Prednisolone,Dexamethasone,Methylprednisolone)
Parenteral(Hydrocortisone,Methylprednisolone,Dexamethasoneetc)
Immunosuppressants
Immunomodulators

9. Preferredrouteforbothcontrollerandrelievertherapy
Advantages:Localeffect,immediateresponseMinimaldosage,fewside
effects
Availableas:Drypowder(DPIs),MetereddoseliquidinhalersMDIs);
Nebulizers
Devices:Spacers(toincreasedrugdelivery)

10. Localsideeffects:throatirritation,voicechange,thrush
(candidainfection),vocalcorddysphonia
Systemicsideeffectsofdrugs:Raremaybegrowth
retardationinyoungchildrencataracts,othersteroideffects

12. Metered Dose Inhalers

13. Dry powder inhalers

14. Tmtofsinusitisandpolyps
ManagingGEreflux
Weightreduction
Sleepdisorderevaluation
Tmtofpsychologicalstress
ManagementofVCDifany
Reducingallergenload,dust,smoke/ETS,pets(etc.)

15. Unable to complete a sentence in one breath
RR > 30/minute
Use of accessory muscles of respiration
HR > 120/minute
Pulsus paradoxus > 25 mm Hg
Extensive inspiratory and expiratory wheeze
PEFR < 50% personal best
PaO2 < 60 mm Hg, PaCO2 > 45 mm Hg
GINA2004

16. 1.Stabilization:Oxygen,hydration
2.Nebulizedbronchodilators
3.Oral/parenteralcorticosteroids
4.Evaluateandtreatconfoundingorexacerbatingfactors
5.Ifrefractorytotreatment,assistedventilationmayberequired.

17. Good,unlesspoorlycontrolled,severeandcontinuouswithfrequent
exacerbation
Compatiblewithnormallifespanandqualityoflife.Toomanyrestrictions
mustbeavoided.
Irreversibleairwayobstructioninsomewithpoorcontrol–remodelledasthma
Somephenotypesofasthmaareassociatedwithriskoffatality–Brittleasthma,
Nearfatalasthma,Steroiddependentasthma.

18. Maintenancetreatment
Labile/Brittleasthma
Steroiddependent
Othercomorbidities
Specificsituations
Pregnancy
Surgery
Concurrentdiseasesanddrugs
Occupationalasthma

19. Acute exacerbations
Acute respiratory failure
Pneumothorax, pneumomediastinum, sub-cutaneous emphysema
Respir infections, pneumonias
Allergic broncho-pulmonary aspergillosis
Airway remodelling, irreversible obstruction
Tmt related complications: Local, systemic

20. Chronicobstructivepulmonarydisease
Upperrespiratorycatarrhs
Hyper-sensitivitypneumonias
Hyper-eosinophilicsyndromes
Bronchiectasis
Children:Acutelaryngotracheo-bronchitis,bronchopneumonia,cystic
fibrosis.,Foreignbodyaspiration

21. Exercise-induced asthma
Occupational asthma
Hyper-sensitivity pneumonia
Eosinophilic syndromes
Obesity-hypoventilation syndromes
Drugs and diets induced asthma
Allergic broncho-pulmonary aspergillosis (ABPA)

22. Colonization of aspergillusfungus in the tracheo-bronchial tree in patients
with chronic asthma. Hypersensitivity to fungal antigens
Clinical Features: Severe attacks, sputum production; hard brown plugs;
hemoptysis
Radiology: CXR and HRCT: Fleeting opacities, typical patterns;
bronchiectasis(usually proximal)
Diagnosis: Skin test: Immediate & delayed +ve
Sputum for aspergillus+ve
Total & Aspergillusspecific IgElevels
Treatment: Oral corticosteroids, Antifungal (Itraconazole)

24. Bikaner
Ahmedabad
Mumbai
Bangalore
Chennai
Secunderaba
d
Nagpur
Kolkata
Kanpur
Chandigar
hh
Trivandrum
Guwahati
Delhi
Shimla
Berhampur
Mysore
INSEARCH Prevalence in adults:
Asthma 2-5%, COPD 3-10%
Jindal et al 2012

25. Risk Factors for COPD
HostFactorsGenes(e.g.alpha1antitrypsindeficiency)
Hyper-responsiveness
ExposureTobaccosmoke
Solidfuelcombustion
Outdoorairpollution
Occupationaldustsandchemicals
Infections
Socioeconomicstatus

26. Tobaccosmoke
Bothcigaretteand‘bidi’smokingareequallyresponsible
EnvironmentalTobaccoSmoke(ETS)exposuremayalsoplaya
contributoryroleespeciallyinnonsmokerindividuals
Solidfuelcombustion
(drieddung,woodandcropresidueforcookingandheating).Itis
responsibleforalargenumberofCOPDintheruralinhabitantsin
generalandwomeninparticular
Outdoorairpollution

27. ClinicalHistory
Cough
Expectoration
Dyspnoea
Exacerbations
PhysicalExamination
PhysicalexaminationisrarelydiagnosticinCOPD.
Physicalsignsofairflowlimitationarerarelypresentuntilsignificant
impairmentoflungfunctionhasoccurred.
However,certainfindingsonclinicalexaminationpointtowardsthediagnosis
ofCOPD.
Clinical Features & Diagnosis

28. AbarrelshapedchestwithincreasedAPdiameter
Hyper-resonantpercussionwithobliterationofcardiacdullness
UniformlydiminishedintensityofBreathsoundwithaprolonged
expiratoryphase
Fineinspiratorycrepitationsandrhonchiarecommonlyheard.
Forcedexpiratorytime(FET)willbeprolongedtomorethan6sec.
Patientmayhavepursedlipbreathing.

29.  Bronchiectasis
Asthma
 Tuberculosis
 Hypersensitivitypneumonias
 Eosinophilicbronchitis
 Otherlungdiseases

30. Requiredfor
Exclusionofalternatediagnosis(D/D)
ConfirmationofdiagnosisofCOPD
•Reversibilitytest
AssessmentofseverityofCOPD
Diagnosisofcomplications
•ABGanalysisandassessingforLTOT

31. Sputum examination
To exclude tuberculosis in suspected patients. Examine sputum smears for
acid fast bacilli (AFB), at least thrice
Chest X-ray
Identify alternate diseases such as fibrocavitarytuberculosis, bronchiectasis,
lung tumours
Detect complications such as chronic corpulmonalepneumothoraxor
pneumonia

33. Spirometryremainsthegoldstandardforconfirmationandstagingof
COPD
SpirometryshouldmeasureFVC;FEV1;andtheFEV1/FVCratio
ThepresenceofapostbronchodilatorFEV1<80%ofthepredictedvaluein
combinationwithaFEV1/FVC<70%confirmsthepresenceofairflow
limitationthatisnotfullyreversible.

34. I(Mild)-ShortactingBDs
II(Moderate)-RegularBD(one/more)
III(Severe)-Bronchodilators
-Inhaledcorticosteroids
-Rxofcomplications
Tobaccocessationandpulmonaryrehabilitationareimportantatallstages

35. 1.ASKabouttobaccouse
2.ASSESSthestatusandseverityofuse
3.ADVISEtostop
4.ASSISTinsmokingcessation
5.ARRANGEfollow-upprogramme

36. 1.Anticholinergics
Tiotropium
Ipratropium
2.Beta-agonists
Longacting–Maintenance
Shortacting–Rescue
3.Combinations(1+2)
4.Oral:Theophyllines,PDE
4inhibitors

37. 1.Causeeffectivebronchodilatation
2.Reducerate&severityofacuteexacerbations
3.Improvequalityoflife
4.Longacting
5.Sideeffects:Dryness,blurredvision,urinaryretention(ifBPH)

38. 1.Oral/parenteralforacuteexacerbations
2.InhaledformoderatetosevereCOPD
Improvelungfunction
Reduceexacerbations
Improvesymptoms&Q.O.L.
Reduceairwayreactivity
Sideeffects:
Lossofbonemineraldensity
Increasedskinbruising

39. 1.Acute exacerbations
Severe airway obstruction
Acute change in baseline lung function
Marked exercise tolerance
Nocturnal hypoxemia
2. Pulmonary hypertension and Chronic corpulmonale
3. Respiratory failure

40. Increaseincough
Chestpain
Increaseinbreathlessness
Increaseinsputumvolumeandchangeinitscolour(togreen,yellow,
bloodstreaked)
Fever
Increasedtiredness
Increaseinoxygenrequirement(forthoseonlong-termoxygentherapy)

41. 1.Increasethedoseand/orfrequencyofcurrentbronchodilatortherapy
2.Addnewbronchodilators
3.Bronchodilatornebulization
4.Parenteraltheophyllines
5.Systemicglucocorticoids
6.Antibioticsforinfections
7.Maintenanceofoxygenation
8.NIVorAssistedVentilationforrefractoryrespiratoryfailure
(Hypoxaemiaand/orhypercapnia)

42. Hypoxemiacommoninhospitalizedpts.
SmallincreaseinFiO2-goodresponse
However,thiscanworsenhypercapnia
dueto:
•ReleaseofhypoxicvasoconstrictionIncreaseddead-space
•Lossofhypoxicrespiratorydrive
Domicilliarylongterm-termoxygentherapyforCOPDwithchronic
respiratoryfailure

43. Non-invasiveventilation(NIV)incasethereisfailuretorespondto
supportivetherapyandcontrolledoxygensupplementation
-Initiateasearlyaspossible
-RR>24andhypercapniawithacidosis
-(pH<7.35)aretheclassicindications
-Nobenefitinmilderexacerbations
IntubationandMechanicalventilationifNIViscontraindicated,has
failed,orisnottolerated

44. Definition:Alterationsinthestructureand/orfunctionoftherightventricle
secondarytodiseasesofthelung,chestwallorlungvasculature–(whichare
notsecondarytothediseasesoftheleftheartorcongenitalheartdiseases).
Manifestswithfeaturesofpulmonaryhypertensionandrightheartoverload/
failure:
Generalizedanasarca,congestedliver,ascites,cyanosis,loudP-2,cardiomegaly
(rt.)
Diagnosis:H/OCOPD
CXR,ECG,ECHO

45. 1.Longtermoxygentherapy
2.Removaloffluidretention–diuretics
3.MaintenanceofCO
2levels
4.Digoxin,ifarterialfibrillation
5.Vasodilators-maybehazardous(Lowersystemicandpulm.BP)
6.TreatmentofCOPD

46. 1.Ruptureofblebs/bullae:Pneumothorax,pneumomediastinum,
subcutaneousemphysema
2.Polycythemia(duetochronichypoxemia)
3.Increasedcoagulationproblems
-Insituthrombosis
-Pulmonarythromboembolism
5.Hyperuricemia(andoccasionallygout)
6.Systemicmanifestations

47. 1.General
Wasting,weightloss,
Nutritionalanomalies,anemia
2.Musculoskeletal
Skeletalmuscledysfunction,
Osteoporosis
Reducedexercisetolerance,performance
3.Cardiovascular
Ischemicheartdisease
Cardiacfailure,Stroke
Systemic manifestations of COPD

48. 4.Endocrinal
Diabetes,
Metabolicsyndrome
Dysfunctionofpituitary,
thyroid,gonadsandadrenals
5.Neuropsychiatric
Depression
Disorderedsleep
Anxiety
Cognitivefunctiondecline

49. Keepoffsmoking
Bronchodilators
Inhaledcorticosteroids
Use/avoidanceofotherdrugs(e.g.antibiotics,mucolytics,sedatives)
Prophylacticvaccination(influenza)
Pulmonaryrehabilitation(multidisciplinarysupportsandmanagement)