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BRONCHIAL ASTHMA

A common chronic inflammatory disease of the

airways characterized by variable and recurring

symptoms

Reversible airflow obstruction

Bronchospasm

Symptoms

Wheezing

Coughing Chest tightness

Shortness of breath

Treatment of acute symptoms is usually with

inhaled short-acting beta-2 agonist (such assalbutamol)

Symptoms can be prevented by avoiding triggers:

o Allergens

o Irritants

o By inhaling corticosteroid

Leukotriene antagonists are less effective than

corticosteroids and thus less preferred

The prevalence of asthma has increased to 300

million people were affected worldwide

In 2009 asthma caused 250,000 deaths globally

Prognosis is generally good

Severity to patients sx frequency >= 12 yrs of

age

Intermittent 2/week

Moderate persistent daily

Severe persistent through the day

Nighttime symptom

Intermittent 1/week but nightly

Severe persistent frequent (often 7x/week)

Asthma is clinically classified according to:

Frequency of symptom

Forced exploratory volume in 1 sec (FEV1)

Peak exploratory flow rate

Classification according to degree of control:

Controlled

Poorly controlled

Uncontrolled

Extracerbations

Asthma may also be classified as:

Atopic (extrinsic) allergy, seasonal

Non-atopic (intrinsic)

Based on whether symptoms are precipitated by

allergies (atopic) or not (non-atopic)

Although asthma is a chronic obstructive

condition, it is not considered as a part of chronicobstructive pulmonary disease

COPD refers specifically to combinations of

disease that are irreversible such as:

o Bronchiectasis

o Chronic bronchitis

o Emphysema

Asthma attack

an acute asthma exacerbated is commonly referred

to as an asthma attack

the classic symptoms are:

o shortness of breath

o wheezing

o chest tightness

the primary symptom of asthma to some people

present primarily with coughing

in severe cases, air motion may significantly

impaired such that no wheezing is heard

Signs with occur during an asthma attack include:

the use of accessory muscles of reparation

(sternocleidomastoid and scale muscles of theneck)

there may be a paradoxical pulse (a pulse that is

weaker during inhalation and stronger during

inhalation)

over-inflation of the chest

a blue color of the skin and nails, may occur from

lack of oxygen

in a mild exacerbated the peak exploratory flowrate (PEFR) is >= 200 l/min or >= 50% of the

predicted best

Moderate is defined as between 80 and 200 L/min

r 25% and 50% of the predicted best

Severe is defined as

80 L/min or of the

predicted best

Insufficient levels of vit. D are linked with severe

asthma attacks

STATUS ATHMATICUS

An acute exacerbation of asthma that does not

respond to standard treatments of bronchodilators

Non selective beta blockers have caused fatal

status asthmaticus

EXERCISE INDUCED

Diagnosis at asthma is common among top

athletes

In the 1996 summer Olympics games, showed that

15% had been activity with asthma, and that 10%

were on asthma medication

High incidence to asthma in sports such as

cycling, mountain biking, and long distancerunning

Lower incidence in weightlifting and diving

Exercise induced asthma can be treated with the

use of a short-acting beta 2 agonist

OCCUPATIONAL ASTHMA

Asthma as a result of (or worsened by) workplaceexposure is a commonly respiratory disease

Estimates by the American Thoracic Society

(2004) suggest that 15-23% of new asthma cases

in adults are work related

In one study monitoring workplace asthma by

occupation, the highest percentage of cases,

occurred among:

o Operators, fabricators, laborers (32.9%)

o Followed by managerial and

professional specialist (20.2%)o In technical, sales, and administrative

support jobs (19.2%)

MOST CASES WERE ASSOCIATED WITH:

The manufacturing (41.4%)

Services (34.2%) industries

Animal proteins, enzymes, flour, natural rubber,latex, and certain reactive chemicals are

commonly associated with work-related asthma

SSX

Wheezing

Shortness of breath

Chest tightness Coughing

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SYMPTOMS ARE OFTEN WORSE

At night

In the early morning

In response to exercise

Cold air

Some people with asthma only rarely experiencesymptoms, usually in response to triggers

Other may have marked persistent airflow

obstruction

GASTRO-ESOPHAGEAL REFLUX DISEASE

Coexists with asthma in 80% with similar

symptoms

This is due to increased lunch pressures,promoting bronchoconstrictions, and through

chronic aspiration

SLEEP DISORDER

due to altered anatomy of the respiratory tract:

o increased upper airway adipose

deposition

o altered pharynx skeletal morphologyo extension of the pharyngeal airway

o leading to upper airway dispose

CAUSE

asthma is caused by environmental and genetic

factors

these factors influence how severe asthma is and

how well it responds to modification

the interaction is complex

studying the prevalence of asthma and related

disease such as eczema and hay fever have yieldedimportant clues about some key risk factors

the strongest risk factor for developing asthma is ahistory of atopic disease

the increase ones risk of hay fever by up to 5x

and the risk of asthma by 3-4x

in children between the ages of 3-14, a positive

skin test for allergies and an increase inimmunoglobulin E increases the chance of having

asthma

in adults, the more allergens one reacts positively

to in a skin test the higher the odds of giving

asthma

DIAGNOSIS

severity of acute asthma exacerbations near-fatal asthma

high PaCO2 and or requiring mechanicalventilation

o Anyone of the following in a person w/ severe

asthma:

Life threatening asthma

Clinical Signs Measurements

-altered level of

consciousnes

Peak flow < 33%

-exhaustion Oxygen saturation