Bronchial Asthma Definition Patho-physiology Diagnosis Management
Asthma prevalence in Saudi Arabia Children and Adolescents: 20 % Adults : 10 %
Pathology of Asthma Inflammation Airway Hyper-responsivenessAirway Obstruction Symptoms of Asthma
Source: Peter J. Barnes, MD Mechanisms: Asthma Inflammation
During an asthma attack…
Sep-15 Asthma Microscopic Pathology Obstructed Inflammed Bronchi
Before 10 Minutes After Allergen Challenge Bronchoconstriction
Sep-15 Thick bronchi with Mucous plugs
Pathophysiology
Source: Peter J. Barnes, MD Asthma Inflammation: Cells and Mediators
ALLERGIC TRIGGERS
Triggers of Asthma (Irritants) Infections Chemicals Diet/Medications Strong Emotions Exercise Cold temperature Exposure to smoke
Chronic inflammation Structural changes Acute inflammation TIMETIME Barnes PJ. Clin Exp Allergy “Real Life” Variability in Asthma symptoms subclinical
diagnosis is obvious
DIAGNOSIS OF ASTHMA History and patterns of symptoms Physical examination Measurements of lung function
Bronchial Asthma Asthma is diagnosed clinically by history and P/E In case of doubt : - Spirometry - Methacholine challenge test
History Tightness of the chest, cough & expectoration, wheeze Comes in episodes, (recurrent ) With exposure to allergens and irritants History of asthma attacks Relieve using salbutamol Allergy in skin, eyes, nose Family history of asthma or allergy
Physical Examination Wheeze /Rhonchi (no crackles) Tachypnea (signs of allergy of skin, nose, eyes) Remember Absence of symptoms at the time of examination does not exclude the diagnosis of asthma
Peak Flow Meter
Managing Asthma: Peak Expiratory Flow (PEF) Meters Allows the patient to assess the status of his or her asthma
What Types of Spirometers Are Available? SpirotelSensaireSatellite RenaissanceKoKoVitalograph 2120
Spirometry: Obstructive Disease Volume, liters Time, seconds FVC = 3.2L 94 % FEV 1 = 1.8L 66 % FEV 1 /FVC = 56% Normal Obstructive
What is Asthma ? A chronic inflammatory disorder of the airway with Infiltration of mast cells, eosinophils and lymphocytes in response to allergens Airway hyper-responsiveness ( twitchy airways) Recurrent episodes of wheezing, coughing and shortness of breath Variable and often reversible airflow limitation (airway obstruction )
ICS = inhaled cortico-steroids budesonide, fluticasone, beclomethasone, ciclosenide, mometasone B 2 Agonists : ( stimulants) Short acting : SABA salbutamol Long Acing : LABA: Rapid acting formeterol Non- Rapid acting salmeterol
budesonide = Pulmicort fluticasone = Flixotide Ciclosenide = Alvesco
Combinations: Symbicort : budesonide + formoterol Seretide: fluticasone + salmeterol Foster: beclomethasone + formeterol
Anti-cholinergic drugs: Ipratropium (Atrovent) inhaler, solution for nebulizer Tiotropium (Spiriva) inhaler
Reliever/ Rescue Salbutamol Bronchodilator (beta 2 agonist) Quickly relieves symptoms (within 2-3 minutes) Not for regular use
Anti-inflammatory Takes time to act (1-3 hours) Long-term effect (12-24 hours) Only for regular use (whether well or not well) Preventer/ Controller
Controller Drugs Inhaled steroids Leukotriene modifiers (montelukast) Anti-IgE (omalizumab =Xolair ) Systemic steroids
Adults Patients with Asthma
Rules of Two Use of a quick-relief inhaler more than: 2 times per week Awaken at night due to asthma symptoms more than: 2 times per month Consumes a quick-relief inhaler more than: 2 times per year Need controller medication
Poor Asthma Control why ? Before increasing medications, check: Inhaler technique Adherence to prescribed regimen Environmental changes Also consider alternative diagnoses
Why inhalation therapy? Oral Slow onset of action Large dosage used Greater side effects Not useful in acute symptoms Inhaled Rapid onset of action Less amount of drug used Better tolerated Very effective
summary Asthma can be controlled but not cured It can present in at any age. It produces recurrent attacks of symptoms of SOB, cough with or without wheeze Between attacks patients with asthma lead normal lives In most cases there is some history of allergy in the family. Understanding the disease, learning the technique and compliance with medications is the key for good control of asthma