1. BRONCHIAL ASTHMA DR.K.PREETHI

2. RESPIRATORY SYSTEM TRACHEA TRACHEA PAIR OF BRONCHI PAIR OF BRONCHI BRONCHIOLES BRONCHIOLES

3. ASTHMA DEFINITION Episodic Episodic Reversible Reversible Bronchoconstriction Bronchoconstriction Due to increased responsiveness to various stimuli Due to increased responsiveness to various stimuli

4. COMMON TRIGER FACTORS Pollen from flowers Pollen from flowers Dust mite Dust mite Pet dander Pet dander Mold Mold

5. PATHOGENESIS Following the entry of antigen various mediators of inflammation are released Following the entry of antigen various mediators of inflammation are released Mast cell Mast cell Neutrophils Neutrophils Eosinophils Eosinophils Lymphocytes Lymphocytes

6. PATHOGENESIS

7. ASTHMATIC AIR WAY

8. PATHOPHYSIOLOGY Contraction of smooth muscle Contraction of smooth muscle Vascular congestion Vascular congestion Edema of bronchial wall Edema of bronchial wall Thick secretions Thick secretions

9. SYMPTOMS Coughing Coughing Wheezing Wheezing Chest tightness Chest tightness Shortness of breath Shortness of breath

10. SIGNS Increased heart rate Increased heart rate Increased respiratory rate Increased respiratory rate Wheezing on auscultation Wheezing on auscultation

11. PHARMOCOLOGY DRUGS THAT INHIBIT SMOOTH MUSCLE CONTRACTION DRUGS THAT INHIBIT SMOOTH MUSCLE CONTRACTION BRONCHODILATORS -Theophylline BRONCHODILATORS -Theophylline BETA 2 AGONIST BETA 2 AGONIST Short acting -Albuterol,Terbutaline Short acting -Albuterol,Terbutaline Long acting -Salmeterol Long acting -Salmeterol

12. INHIBITORS OF INFLAMMATION CORTICOSTEROIDS CORTICOSTEROIDS MAST CELL STABILIZERS MAST CELL STABILIZERS

13. MANAGEMENT ROUTES OF ADMINISTRATION ROUTES OF ADMINISTRATION Inhalational Inhalational Oral route Oral route Intravenous route Intravenous route

14. MEDICAL MANAGEMENT MILD INTERMITENT ASTHMA SYMPTOMS <2TIMES/WEEK AWAKENING AT NIGHT <2TIMES/MONTH SHORT ACTING B2 AGONIST

15. MILD PERSISTANT ASTHMA SYMPTOMS >2TIMES/WEEK AWAKENING AT NIGHT >2TIMES /MONTH SHORT ACTING& LONG ACTING B2 AGONIST LOW DOSE STEROID

16. MODERATE PERSISTANT ASTHMA SYMPTOMS DAILY AWAKENING AT NIGHT >1/WEEK INHALED STEROID LONG ACTING SALMETEROL 2 PUFF/BD

17. SEVERE PERSISTANT ASTHMA SYMPTOMS PRESENT CONTINOUSLY FREQUUENT NIGHT AWAKENING HIGH DOSE STEROID LONG ACTING BRONCHO DIL LONG TERM ORAL STEROID

18. PRE OPERATIVE STEPS ASSESS THE RESPIRATORY STATUS IN SUPINE POSTURE ASSESS THE RESPIRATORY STATUS IN SUPINE POSTURE SHIFT THE PATTIENT IN WHEEL CHAIR SHIFT THE PATTIENT IN WHEEL CHAIR KEEP VENFLON IN POSITION KEEP VENFLON IN POSITION

19. INHALERS MEDICAL DEVICE MEDICAL DEVICE USED TO DELIVER USED TO DELIVER MEDICATIONS IN TO THE BODY MEDICATIONS IN TO THE BODY VIA LUNGS VIA LUNGS

20. METERED DOSE INHALER DRY POWDER INHALER

21. INSTRUTION TO USE Remove cap from mouth piece.Shake well. Sit up straight, lift the chin up. Take few deep breath Put the mouth piece in mouth, seal with lips As you start to breathe in simultaneously press on the inhaler to release one puff. For the second puff wait for 30 minutes.

22. NEBULIZER It is a device used to administer medication in the form of mist It is a device used to administer medication in the form of mist

23. PARTS OF NEBULIZER Mouth piece or mask Mouth piece or mask Cup to hold the medications Cup to hold the medications Tshaped part Tshaped part Thin plastic tube Thin plastic tube Machine Machine

24. INSTRUCTION TO USE Measure the right amount of medications. Attach the mouth piece or mask to the medication cap. Attach the cap to the machine using long clear tubing. Turn the machine on. Put the mouth piece or the face mask.

25. Take slow deep breath in and out inhaling the mist. Take slow deep breath in and out inhaling the mist. Hold each breath 1-2 sec before breathing out. Hold each breath 1-2 sec before breathing out. All the medication must to be inhaled with in 5-10 minutes. All the medication must to be inhaled with in 5-10 minutes.

26. CARE OF THE NEBULIZER After each use take apart all the parts. After each use take apart all the parts. Rinse the mouth piece or mask,T connection medication cap. Rinse the mouth piece or mask,T connection medication cap. Allow it to dry. Allow it to dry. Once or twice a week, after rinsing soak the parts in antiseptic solution. Once or twice a week, after rinsing soak the parts in antiseptic solution. Clean the surface of the machine with damp cloth. Clean the surface of the machine with damp cloth.

28. ACUTE SEVERE ASTHMA management

29. MANAGEMENT Back rest Back rest O2 by mask or cannula 2-4 lit/min O2 by mask or cannula 2-4 lit/min Broncho dilators Broncho dilators Systemic steroids Systemic steroids IV methyl prednisolone IV methyl prednisolone Oral steroids Oral steroids Nebulised salbutamol Nebulised salbutamol Hydration with iv fluids. Hydration with iv fluids.