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BRONCHIAL ASTHMA It is a chronic inflammatory condition which has three characteristics •Airflow limitation which is usually reversible spontaneously or with treatment •Airway hyperresponsiveness to a wide range of stimuli •Inflammation of the bronchi CLASSIFICATION •Extrinsic Implying a definite external cause •Intrinsic or cryptogenic •No causative agent ETIOLOGY Atopy and allergy Airway hyperactivity Precipitating Factors Occupational sensitizers Non specific factors •Cold air and exercise •Atmospheric pollution and irritant dusts, vapors and fumes •Diet •Emotion •Drugs PATHOGENESIS Mast cells Epithelium Basement Membrane Nerves Macrophages and lymphocytes Eosinophils Mediators - LTD4, Thromboxanes LTB4, PAF CLINICAL FEATURES Wheezing Episodic shortness of breath Cough INVESTIGATIONS No single satisfactory diagnostic test for all asthmatic patients •Lung function test •Peak flow charts •Exercise test •Histamine or methacholine bronchial provocation test •Trial of corticosteroids •Blood and sputum test (Eosinophils > 0.4*109/L) •Chest X-ray •Skin tests •Allergen provocation tests MANAGEMENT Goals •To abolish symptoms •To restore normal or best possible long-term airway function •To reduce the risk of severe attacks •To enable normal growth to occur in children •To minimize absence from school or employment This Involves •Patient and family participation •Avoidance of identified causes where possible •Use of the lowest effective doses of convenient medications to minimize short term and long term side effects CONTROL OF EXTRINSIC FACTORS •House dust mite •Pets •Moulds •Certain food stiff (Peanuts etc) •Drugs e.g Aspirin, Beta-Blockers •Active and passive smoking •Preservatives and colouring materials e.g tartrazine DRUG TREATMENT B2 adrenoceptor agonist Anticholinergic bronchodilator Antiinflammatory drugs ● Sodium cromoglycate ● Nedocromil sodium Inhaled corticosteroid Oral Corticosteroids Antibiotics Leukotriene receptor antagonists Table???? MANAGEMENT OF SEVERE ASTHMA Status Asthmaticus •Inability to complete a sentence in one breath •Respiratory rate >25 breaths per minute • Tachycardia >110 beats min-1 •PEFR <50% of predicted normal or best Treatment •Oxygen 40-60% •Nebulized salbutamol 5mg or terbutaline 10mg •Hydrocortisone sodium succinate 200mg IV •Nebulized Ipratropium bromide 0.5mg •Arterial blood gases •Chest X-ray to exclude pneumothorax
