Download Bronchial Astma

Prepared by:
Ibrahim Tawhari.
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:


A common problem especially in children.
The prevalence of asthma among school children in
KSA:
 Range:
4%-23%.
 Riyadh:
10%.
 Jeddah: 12%
PATHOPHYSIOLOGY:

During an acute asthmatic attack:
Airways obstruction
V/Q mismatch
Hypoxemia
Hyperventilation
PCO2
PH (Respiratory Alkalosis)
PATHOPHYSIOLOGY:
Muscle Fatigue
Ventilation
PCO2
PH (Respiratoty Acidosis)
TRIGGERS
TRIGGERS:


URTIs.
Allergens / Irritants:
Mould
Pet dander
Feather
House Dust
Smoking
Air Pollution
Pollens
TRIGGERS:

Drugs:
Aspirin

Emotion & Anxiety:
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:
Fatigue
Silent Chest
Expiratory Effort
Cyanosis
 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,
 Local
eczema, nasal polyps, URTI, …
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
 Features
of the patient:
of disease…
 Goal of management…
 How to do self monitoring…
 Red flags…
Management:

Pharmacologic Management:
 Symptomatic
relief in ACUTE ATTACKS:
acting 2-agonists: albuterol, terbutalin, mataprotrenol,…
 Anticholinergic bronchodilators…
 Steroids…
 Long acting 2-agonists: Salmetrol, formetrol,…
 Short
Management:

Pharmacologic Management:
 CHRONIC
 Long
MANAGEMENT:
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:
THE END….
Thanks…