Bronchial Asthma Seminar

7/24/2019 Bronchial Asthma Seminar

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BRONCHIAL ASTHMA


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BRONCHIAL ASTHMA

GROUP MEMBERS

Shathish a/l Thendayuthapani012012100088

Eelyn Sya!"ala a/p #aul Ra$012012100022

Ra"es a/l #%%nudu!ai 01201&0'021(


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DEFINITION

PATHOPHYSIOLOGY

TRIGGER FACTORS

CLINICAL FEATURES

DIAGNOSIS

SHATHISH A/L THEN)A*+THA#ANI

012012100088


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DEFINITION

Asthma is defined as a chronic inflammatory disorder of the

airways in which many cells and cellular elements play a role.

In susceptible individuals this inflammation causes recurrent

episodes of wheezing, breathlessness, chest tightness and

coughing particularly at night or early in the early morning. These episodes are usually associated with widespread but

variable airflow obstruction that is often reversible either

spontaneously or with treatment.

Asthma is a common and potentially fatal disorder,


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PATHOPHYSIOLOGY


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TRIGGER FACTORSA allergens pollens, animal dander, dust mites, mould

B bronchial infection

C cold air, exercise

) drugs aspirin, !AI"s, #$bloc%ers

E emotion stress, laughter

- food sodium metabisulphate, seafood, nuts

.

gastro$esophageal reflux

H hormones pregnancy, menstruation

I irritants smo%e, perfumes, smells

&ob wood dust, flour dust, isocynates


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CLINICAL FEATURES

The principal symptoms of asthma are '$

wheezing attacks

chest tightness

breathlessness

cough

octurnal symptoms ( usually worst during the night)

Note: Asthma should b sus!"td #$"h#ld%$ th %"u%%$t $o"tu%$al "ou'h ( #$!o!l th #$t%m#tt$t d)s!$oa o% "hst

t#'ht$ss* s!"#all) a+t% ,%"#s-


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DIAGNOSIS

The diagnosis of asthma is predominantly clinical * based on

a characteristic history.

!upportive evidence is provided by the demonstration of

variable airflow obstruction.

Clinical history compatible with asthma plus either/or :

FEV1 15% increase ollowing a!ministration o abroncho!ilator/ trial o corticosteroi!s "#re!nisolone $mg!aily or & weeks'

( &% !iurnal )ariation on $ !ays in a week or & weekson #EF !iary

FEV1 15% !ecrease ater * mins o e+ercise


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REFERENCES

)aids%ns #!iniples and #!atie % Mediine322nd Editi%n

M+RTA.HS .ENERAL #RACTICE3 'th Editi%n3M4!a5 HILL

555,e"ediine,"edsape,%"


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CHRONIC ASTHMAE.ELYN SYARMALA A/P

PAUL RA0123123211133


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CONTENTS Assess"ent % asth"a

see!ity

N%n6pha!"a%l%4ialt!eat"ent

#ha!"a%l%4ial t!eat"ent


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S4%#t)/G%ad Status b+o% t%atm$t Lu$' +u$"t#o$FE.2o% PEFR 5 6

!%d#"td7

Inte!"ittent Epis%di Sy"pt%"s 7 5eely Ni4ht sy"pt%"s 9 2/"%nth Mild %asi%nal sy"pt%"s

5ith e:e!ise

; 80 Sient? chest

6. Cyanosis

8. Chest retraction

:. 2ncreased res%iratory rate @ %use rate

. -eak Bo' DD40min or 3D %redicted;E$

D.S-o/ D


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HISTORY

Assessment of medica history shoud address)

. ;reuency and se"erity of recent sym%toms,9a%idity of onset

/. Characteristic of sym%toms

1. *istinguish daytime and nocturna sym%toms

freuency3. History of %ast0%resent smoking

5.Acti"ities, acute iness, en"ironmenta e(%osure,e(%osure to aergens, %sychoogica stress, use of7SA2*s that may trigger e%isodes

6. ;amiy history of asthma0 ato%ic disease8. *etaied occu%ationa history

:. E&ects of inhaers !if %atient is on medication#


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:. amount of inhaed F+agonist sef+administered during the e(acerbation

. Whether sym%toms are attributabe toasthma

D. 2dentify is %atient is at risk for seriousmorbidity and mortaity from asthma


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PHYSICAL EXAMINATION

. Genera a%%earance of %atient, *i&icuty intaking

/.$ita signs+ Heart rate, res%iratory rate,


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INVESTIGATIONS

. -umonary function test+ -E;9, S%irometry

/. Measurement of o(ygen saturation by %useo(imetry+ To assess "entiaton status

1.Arteria bood gas anaysis+ ;or %atients 'itho' o(ygen saturation on room air, or the

%atient 'ho does not res%ond to initiatreatment 'ith ;E$remaining ess than 1D

3. Chest +ray !To rue out u%%er air'ay causes ofobstruction, sus%icion of %neumonia or%neumothora(#

5. Serum %otassium concentration6. ;u bood count, ECG, microbioogica

in"estigation !if reuired#


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MA7AGEME7T I;ACUTE ASTHMA

ATTACJ


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Management of Acute se"ere Asthma

. Continuous assessment of %atient

/. I(ygen 3D+6D

1. Monitoring of -E;9, I(ygen saturation

3.Administer re%eat sabutamo 5mg 'ithi%ratro%ium bromide 5DDug by nebuizer

5. Hydrocortisone /DDmg 2$ 3 houry for /3hours

6. -rednisoone continued at 6Dmg oraydaiy for / 'eeks

8.Arteria bood gas measurement !if-aCI/ increased, %atient may need

"entiation#


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:. Chest +ray to e(cude %neumothora(

. 2f no im%ro"ement, 2$ MgSI3 ./+/.Dgo"er /D minutes or amino%hyine 5mg0kgoading dose o"er /D minutes foo'ed bycontinuous infusion at mg0kg0hour

D. 2f no im%ro"ement, transfer to 2CU


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;oo' U% after an E(acerbation

-atients must be foo'ed u% unti sym%toms andung function test return to norma.

9e"ie' on)

a. -atients?s understanding of the cause ofe(acerbation

b. Modi=abe risk factors of e(acerbations

c. Understanding of %ur%ose of medications, andinhaer techniue skis

d. 9e"ie' and re"ise 'ritten asthma action %ane. *iscuss medication use and adherence to 2CSand ICS


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ROLES OF TABLET

PREDNISOLONE* TABLETSALBUTAMOL* LABA


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Tabet -rednisoone

. Used mainy for e(acerbations

/. Gi"en 'ith the usua inhaed corticosteroids andbronchodiators

9escue causes of ora steroids)

1. To contro e(acerbations of asthma

3. Worsening of sym%toms and -E;

5. Inset or 'orsening of see% disturbance byasthma

6. Morning sym%toms %ersist ti midday

8. *iminishing res%onse to inhaed bronchodiators


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*ose

U% to mg0kg0day for +/ 'eeks !1D+6D mg daiy#

Action and Use

Short term treatment !5+8 days# is im%ortanteary in the treatment of se"ere acute

e(acerbations, 'ith main e&ects seen after 3+6hours. Ta%ering reuired if treatment gi"en formore than / 'eeks.

Side e&ects

Isteo%orosis, gucose intoerance, adrenasu%%ression and easy bruising 'ith ong+termuse


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Tabet Sabutamo

A ty%e of seecti"e beta / agonist drugIra administration rarey reuired and notrecommended

2nhaed drugs %roduce measureabe

bronchodiation in +/ minutes and %eak e&ectsby D+/D minutes


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4ong Acting


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Combinations of ong acting beta+/ agonist andinhaed corticosteroids

Generic Name Brand Name

;ormetero andbudesonide

Symbicort

;ormotero andmometasone

*uera

Sametero andButicasone

Ad"air


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9E;E9E7CES

Murtagh?s Genera -ractise 5thEdition

*a"idson?s -rinci%es of Medicine //nd

Edition

'''.ginasthma.org

'''.emedicine.medsca%e.com

'''.asthma%artners.org South African Medica ourna !SAM#


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HAT PATIENT SHOULD DO HEN HA.ING ASTHMA


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HAT PATIENT SHOULD DO HEN HA.ING ASTHMAATTAC; AT HOME


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Bronchial Asthma Seminar

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