Bronchial Astma

Ibrahim Tawhari.Prepared by:

Scernario:

Khalid 14 years old come to the clinic c/o shortness of breath for one day duration.

He is a known asthmatic patient for more than 8 years, he visits clinic frequently.

His school performance is below average, with frequent absence from school due to his illness.

What is Bronchial Asthma??

It is a chronic inflammatory disorder of the airways resulting in EPISODES of: Reversible bronchospasm airflow

obstruction.

Associated with airway HYPER-RESPONSIVENESS to endogenous or exogenous stimuli.

ASTHMA IN KSA

Asthma in KSA:

A common problem especially in children.

The prevalence of asthma among school children in KSA: Range: 4%-23%.

Riyadh: 10%. Jeddah: 12%

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY:

During an acute asthmatic attack:

PATHOPHYSIOLOGY:

TRIGGERS

TRIGGERS:

URTIs. Allergens / Irritants:

Pet dander

House Dust

MouldPollens

Feather Smoking Air Pollution

TRIGGERS:

Drugs:

Emotion & Anxiety:

Aspirin NSAIDs -Blockers

TRIGGERS:

Others:

Cold Air Exercises

GERD

SIGNS & SYMPTOMS…

SYMPTOMS & SIGNS:

Tachypnea, Wheezing, Chest tightness, Cough (especially nocturnal), sputum

production.

RED FLAGS…

RED FLAGS:

FatigueExpiratory Effort

Cyanosis

Silent Chest LOC

Respiratory Distress:

Nasal flaring, tracheal tug Inability to speak Accessory muscle use, intercostal

indrawing Pulsus paradoxus

DIAGNOSIS

DIAGNOSIS:

History: Is it the first time??? Recurrent???

If first attack Hyperactive airway disease. SOB, Cough, sputum,… Nocturnal attacks? Effect on daily activities?? Frequency? Look for any triggers… Family History… Drug History…

DIAGNOSIS:

History: Atopic manifestation:

Atopy Triad

DIAGNOSIS:

P/E: General Appearance, Vital signs: Tachypnea, pulsus paradoxus, fever,…???

General Examination: Cyanosis, eczema, nasal polyps, URTI, …

Local Examinations: Inspection: Palpation: Auscultation: Percussion

DIAGNOSIS:

Investigations:

O2 saturation.

ABGs: PO2 during attack (V/Q mismatch). PCO2 in mild asthma (hyperventilation)… But, normal or PCO2 ominous sign (resp. muscle fatigue).

PFTs: May not be possible during attacks… Done when patient is stable…

DIAGNOSIS:

Investigations: PFTs:

Spirometry: FEV1:

Improvement with medications..

MANAGEMENT

Management:

Non-Pharmacologic Management:

Avoid allergens…

Education of the patient: Features of disease… Goal of management… How to do self monitoring… Red flags…

Management:

Pharmacologic Management:

Symptomatic relief in ACUTE ATTACKS:

Short acting 2-agonists: albuterol, terbutalin, mataprotrenol,…

Anticholinergic bronchodilators… Steroids… Long acting 2-agonists: Salmetrol, formetrol,…

Management:

Pharmacologic Management:

CHRONIC MANAGEMENT: Long Term Prevention of Attacks… Inhaled or oral steroids… Anti-allergic: Na chromoglycate, Nidocromile,.. Long acting 2-agonists: Salmetrol, Formetrol,… Aminophyllins… LT receptors antagonists: zileuton, zafirlukast,

montilukast,..

Management:

FOLLOW UP

Criteria of Controlled Asthma:

Assessment of Control:

Thanks…

THE END.…