1. Ibrahim Tawhari. Prepared by:

2. 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.

3. 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.

7. 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%

10. PATHOPHYSIOLOGY:  During an acute asthmatic attack:  PH (Respiratory Alkalosis)  PCO2 Hyperventilation Hypoxemia V/Q mismatch Airways obstruction

11. PATHOPHYSIOLOGY:  PH (Respiratoty Acidosis)  PCO2  Ventilation Muscle Fatigue

12. TRIGGERS

13. TRIGGERS:  URTIs.  Allergens / Irritants: Pet danderHouse Dust Mould Pollens FeatherSmokingAir Pollution

14. TRIGGERS:  Drugs:  Emotion & Anxiety: Aspirin NSAIDs  -Blockers

15. TRIGGERS:  Others: Cold AirExercises GERD

16. SIGNS & SYMPTOMS…

17. SYMPTOMS & SIGNS:  Tachypnea,  Wheezing,  Chest tightness,  Cough (especially nocturnal), sputum production.

18. RED FLAGS…

19. RED FLAGS: Fatigue  Expiratory Effort Cyanosis Silent Chest  LOC

20. Respiratory Distress:  Nasal flaring, tracheal tug  Inability to speak  Accessory muscle use, intercostal indrawing  Pulsus paradoxus

21. DIAGNOSIS

22. 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…

23. DIAGNOSIS:  History:  Atopic manifestation: Atopy Triad

24. DIAGNOSIS:  P/E:  General Appearance,  Vital signs: Tachypnea, pulsus paradoxus, fever,…???  General Examination: Cyanosis, eczema, nasal polyps, URTI, …  Local Examinations: Inspection: Palpation: Auscultation: Percussion

25. DIAGNOSIS:  Investigations:  O 2 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…

26. DIAGNOSIS:  Investigations:  PFTs: Spirometry: FEV1: Improvement with medications..

27. MANAGEMENT

28. Management:  Non-Pharmacologic Management:  Avoid allergens…  Education of the patient: Features of disease… Goal of management… How to do self monitoring… Red flags…

29. Management:  Pharmacologic Management:  Symptomatic relief in ACUTE ATTACKS: Short acting  2-agonists: albuterol, terbutalin, mataprotrenol,… Anticholinergic bronchodilators… Steroids… Long acting  2-agonists: Salmetrol, formetrol,…

30. Management:  Pharmacologic Management:  CHRONIC MANAGEMENT: Long 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,..

31. Management:

32. FOLLOW UP

33. Criteria of Controlled Asthma:

34. Assessment of Control:

35. Thanks… THE END….