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Bronchial Asthma Dr. Saraswathi Ramesh
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Definition Obstructive pulmonary disease characterised by hyper-responsiveness of bronchial mucosa causing narrowing of the bronchi in response to a wide range of stimuli resulting in cough, wheeze, thightness of chest and shortness of breath which is worst during night
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Types Atopic or Early onset / Extrinsic
Late onset (Non-atopic) / Intrinsic
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Applied Anatomy & Physiology
Upper Respiratory tract Nose, Nasopharynx, Larynx Lined by vascular mucous membrane with ciliated epithilium Lower Respiratory tract Trachea, bronchi Lined by ciliated epithilium as far as terminal bronchioles
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Applied Anatomy & Physiology
Larynx and large bronchi are richly supplied with sensory nerve receptors involved in the cough reflex. Acinus is the gas exchange unit of the lung and comprises branchning respiratory brochioles leading to clusters of alveoli
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Incidence 10-20% population Prevalence increasing
Mortality due to asthma unchanged inspite of medical advances
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Aetiology Allergens Skin test positive Skin test negative
Early Onset Extrinsic Atopic Infection Exercise Environment Occupation Drugs Emotion Late Onset Intrinsic Non-atopic Skin test positive Family history of allergic disorders Skin test negative Family history absent
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Clinical Features Episodic Asthma No symptoms between episodes
Paroxysms of wheeze and dyspnoea Triggered by allergens, exercise, viral infections, eg. cold
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Clinical Features Severe Acute Asthma
Was known as ‘status asthmaticus’ Life-threatening situation Orthopnoea Unproductive cough with respiratory distress Tachycardia, pulsus paradoxus, sweating, central cyanosis
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Clinical Features Chronic Asthma
Chest tightness, wheeze, breathlessness on exertion Spontaneous cough and wheeze during night Episodes of severe acute asthma with respiratory infection
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Clinical Features During the attack the chest is held in the position of full inspiration Decreased breath sounds with ronchi ‘silent chest’ during severe attack ‘pigeon-chest’ deformity
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Investigation X-ray Chest Pulmonary function tests
FEV1, VC, PEF Arterial blood gases PaO2, PaCO2 Skin hypersensitivity tests
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Preventive Measures Pollens
Try to avoid exposure to flowering vegetation. Keep bedroom windows closed Mites in house dust Vacuum clean mattress daily Shake out blankets daily Dust bedroom thourghly Animal dander Avoid contact with dogs, cats, horses or other animals
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Preventive Measures Feathers in pillows or quilts
Substitute latex foam pillows and terylene quilts Drugs (eg, beta-adrenoceptor antagonists) Avoid all preperations of relevant drugs Foods Identify and eliminate from diet Industrial chemicals Avoid exposure or change occupation
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Management Hyposensitization
Subcutaneous injection of initially very small, but gradually increasing doses of extracts of allergens
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Chronic persistent asthma
5 4 plus regular oral steroids 4 3 plus regular bronchodilators 3 High dose inhaled corticosteroids 2 Regular inhaled corticosteroids – small dose 1 Occasional short-acting-Beta2-adrenoceptor agonists
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Acute Severe Asthma Oxygen
High doses of inhaled beta2 adrenoceptor agonists Systemic steroids Assisted ventillation
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THANK YOU
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