1. DR. SRINIVASAN

2. Goals of the lecture Definition of asthma & brief pathogenesis Initial diagnosis and ddx Factors that can trigger or aggrevate asthma Classify asthma and assessment of control Commonly used medications

3. What is asthma ? Leading chronic illness in childhood major public health problem school absenteeism 15 million days a year Hyper-reactivity of airways to stimuli Widespread bronchial obstruction and inflammation High degree of reversibility of the process

4. ASTHMA IS MANAGEABLE IF CHILDREN AND FAMILIES HAVE ACCESS TO QUALITY HEALTH CARE & EVIDENCE BASED INTERVENTIONS HAVE PROVEN TO BE EFFECTIVE

5. Prevalence Accounts for 2.2 million pediatrician visits per year 2-10 % children less than 10 are affected incidence higher in low income areas 60% of children symptom free by 20 years 80% have symptoms by 5 years 1 parent 25% risk 2 parents 50% risk

6. Pathophysiology of Asthma INFLAMMATION AIRWAY HYPERRESPONSIVENESS AIRWAY OBSTRUCTION CLINICAL SYMPTOMS

7. GENETIC FACTORS CYTOKINE RESPONSE PROFILES ENVIRONMENT ALLERGENS POLLUTION INFECTIONS EXERCISE STRESS ALTERED INNATE AND IMMUNE RESPONSE LOWER AIRWAY INFECTION PERISISTENT WHEEZING AND ASTHMA

8. Inhaled allergen, osmotic stm Activates and releases macrophages and mast cells and lymphocytes (imbalance between TH1 and TH2 increased TH2) Inflammatory mediators released like leukotrienes and cytokines (mainly IL4, IL5,IL6, IL9) Releases IgE -attaches to mast cells release of eosnophils from bone marrow have inflamatory enzymes and release leukotrienes Stimulates bronchoconstriction and airway inflammation and mucous hypersecretion Sloughing of Epithelium

9. Cytokine imbalance Increase TH2 Widespread Ab use Western Lifestyle Urban Environment Sensitization to dust mites & roaches Th1 Th2 CYTOKINE BALANCE Protective immunityAllergic diseases Increase Th1 Presence of older siblings Early exposure to day care Rural environment Exposure to dander of dog and cat early in life

10. The Importance of Genetics Genetics plays an important role - no genes to date identified

11. WHY DO WE HAVE TO CONTROL ASTHMA? Persistent severe inflammation leads to airway remodeling and permanent loss of function which is clinically significant

12. COMPONENTS IN MANAGEMENT OF ASTHMA DIAGNOSIS OF ASTHMA IDENTIFY COMORBID CONDITIONS PRECIPITATING FACTORS ASSESMENT AND MONITORING EDUCATION FOR PARTNERSHIP IN CARE ENVIRONMENTAL CONTROL PHARMACOLOGICAL THERAPY

13. Signs and symptoms Nocturnal cough, chest tightness wheezing, sob, tachypnea, tachycardia, pulses paradoxus abdominal pain vomiting relieves symptoms severe obstruction- barrel chest Symptoms worsen with allergen exposure spirometry for kids more than 5 years of age

14. Differential Diagnosis Allergic rhinitis or sinusitis, GERD FB Large airway obstruction like laryngomalacia bronchiolitis CF Heart disease Aspiration

15. Assessment and monitoring SEVERITY CONTROL IMPAIRMENT RISK

16. Environmental Control Control of House dust and mites Humidity 30-50% inside house Remove carpet and stuffed toys Wash toys in water with soap or leave in freezer Animal out of the bedroom Encase mattress and pillows in dust proof covers Wash sheets and blankets weekly with hot water

17. Environmental control (Cont.) Roaches Food out of bedrooms Food and Garbage contained use gel or spray Pollen Cold air

18. Patient Education Education in schools and health fairs AAP(Asthma Action Plan) Encourage positive lifestyle behaviors

19. Any questions?