asthma case presentation
TRANSCRIPT
ASTHMA
Dr Zain Ul AbidinBahawal Victoria [email protected]
Definition
It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day.
Wheezing whistling sound produced by resp airways during breathing2
CausesAHR : airway hyper-reactivity is the main cause of asthma
Airway hyper reactivity
Exaggerated response of the airways for a stimulus which triggers little or no response in normal people
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Other Contributing Factors1.allergan exposure 2.dietary deficiency of antioxidants 3.aspirin (lipoxigenase pathway is intact)4.other drugs(OCP, cholinergic drugs,B blockers)5.exercise (non humidified inhaled air is a trigger)
Pathogenesis3 basic characteristics identified are;A. airway hyper reactivityB. airway inflamationC. airway obstruction
Constricted airways in asthma
Types of asthma1.extrinsic (atopic)2.Intrinsic or adult onset (can be atopic or non atopic)3.exercise induced4.child onset (atopic)5.Occupational6.aspirin induced(lipoxigenase pathway causes bronchoconstriction)7.nocturnal8.pregnancy
Clinical presentationThe patient will be presenting the following symptoms
RECURRENT EPISODES OF Breathlessnes Wheezing Chest tightness Cough (may be the only presentation)
Diurnal patternCharacteristically there is a diurnal pattern.
Symptoms worsen in the early morning
Nocturnal asthmaIf the condition is not properly managed ,there would be nocturnal asthma
Cough and wheezing disturbing sleep
DIAGNOSIS
DiagnosisMostly clinical diagnosis
Symptoms. Recurrent Episodes ofbreathlessnessCoughingWheezingChest tightness
Signs of asthmaSigns
Rapid shallow breathing Pallor or cyanosis due to obstructionHyperexpansion of the chest
Tachycardia for the compensationTachypnea Frequent pausing to catch breath while talking
Investigations Routine pulmonary function testNormal or signs of obstruction
Dispropotionately Decreased FEV /FVC + hyperinflation(inc VC)
and improvement with bronchodilators
FEV is the frced exp vol in 1 second.FVCvol which can be forcibly blown out after full inspiration15
Spirometry
InvestigationsChest X-rayNormal in asymptomatic patientsHyperinflation in symptomatic patients
Hyperinflation of lungs
InvestigationsPeak Flow MeasurementsDiurnal variation in PEF of more than 20% is considered diagnostic
Peak flow m for measuring the resp calibre,and spirometry for the assesment of lung volpeak exp flow is the max speed of expiration 19
InvestigationsSkin Tests
to establish atopy
atopic=allergic type of asthma dua to any allergan20
InvestigationsBlood tests
Eosinophila and increased IgE levels in atopy
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Management
Management(stepwise approach)Step One.
For patients with mild intermittent asthma_symptoms less than once a week for 3 mnths_less than 2 nocturnal episodesOccasional inhalational use of short acting B adrenoreceptor agonists
Eg salbutamol or terbatuline
ManagementStep Two.introduction of regular preventor therapy..
Inhaled B agonists + Inhaled corticosteroids (eg beclomethasone)
In patients with _exacebration of asthma in last 2 yrs_uses B agonist inhaler 3 times a week or more_reports symptoms three times a week or more_presentation of nocturnal asthma
ManagementStep 3. add on therapy
For patients who are not controlled even by ICS.
Long acting B agonists are added eg salmeterol,formoterol.
Inhaled B agonists + Inhaled corticosteroids + Long acting B agonists
ManagementStep Four. Addition of a 4th drug (if step 3 is not effective)
Nasal corticosteroids are addedInhaled B agonists + Inhaled corticosteroids + Long acting B agonists + nasal corticosteroids
Step Five. Continuous or frequent use of oral Steroids
Prednisolone therapy is prescribed at the lowest amount to control symptoms
ManagementStep Down Therapy
Once asthma control is established,the dose of ICS should be titrated.
Decreasing the dose by 25-50% every 3 months is the reasonable strategy for most patients
Management of acute severe asthmaAcute severe asthmaPEF 33-50%Respiratory rate 25/min or moreHeart rate 110/min or moreInability to complete sentence in 1 breatheManagement1.Oxygen at high concentration (humidified if possible)2.High doses of Inhaled bronchodilators (via nebulizer)3.Systemic corticosteroids4.Intravenous fluids
Oxygen therapy