BRONCHIAL ASTHMA A common chronic inflammatory disease of the airways characterized by variable and recurring symptoms Reversible airflow

ow obstruction Bronchospasm Symptoms Wheezing Coughing Chest tightness Shortness of breath Treatment of acute symptoms is usually with inhaled short-acting beta-2 agonist (such as salbutamol) Symptoms can be prevented by avoiding triggers: o o o Allergens Irritants By inhaling corticosteroid

Controlled Poorly controlled Uncontrolled Extracerbations

Severe is defined as

80 L/min or

of the

predicted best Insufficient levels of vit. D are linked with severe asthma attacks

Asthma may also be classified as: Atopic (extrinsic) allergy, seasonal Non-atopic (intrinsic) Based on whether symptoms are precipitated by allergies (atopic) or not (non-atopic) Although asthma is a chronic obstructive condition, it is not considered as a part of chronic obstructive pulmonary disease COPD refers specifically to combinations of disease that are irreversible such as: o o o Bronchiectasis Chronic bronchitis Emphysema

STATUS ATHMATICUS An acute exacerbation of asthma that does not respond to standard treatments of bronchodilators Non selective beta blockers have caused fatal status asthmaticus EXERCISE INDUCED Diagnosis at asthma is common among top athletes In the 1996 summer Olympics games, showed that 15% had been activity with asthma, and that 10% were on asthma medication High incidence to asthma in sports such as cycling, mountain biking, and long distance running Lower incidence in weightlifting and diving Exercise induced asthma can be treated with the use of a short-acting beta 2 agonist OCCUPATIONAL ASTHMA Asthma as a result of (or worsened by) workplace exposure is a commonly respiratory disease Estimates by the American Thoracic Society (2004) suggest that 15-23% of new asthma cases in adults are work related In one study monitoring workplace asthma by occupation, the highest percentage of cases, occurred among: o Operators, fabricators, laborers (32.9%) o Followed by managerial and professional specialist (20.2%) o In technical, sales, and administrative support jobs (19.2%) MOST CASES WERE ASSOCIATED WITH: The manufacturing (41.4%) Services (34.2%) industries Animal proteins, enzymes, flour, natural rubber, latex, and certain reactive chemicals are commonly associated with work-related asthma SSX Wheezing Shortness of breath Chest tightness Coughing

Leukotriene antagonists are less effective than corticosteroids and thus less preferred The prevalence of asthma has increased to 300 million people were affected worldwide In 2009 asthma caused 250,000 deaths globally Prognosis is generally good Severity to patients sx frequency >= 12 yrs of age Intermittent <= 2/week Mild persistent >2/week Moderate persistent daily Severe persistent through the day

Asthma attack an acute asthma exacerbated is commonly referred to as an asthma attack the classic symptoms are: o shortness of breath o wheezing o chest tightness the primary symptom of asthma to some people present primarily with coughing in severe cases, air motion may significantly impaired such that no wheezing is heard Signs with occur during an asthma attack include: the use of accessory muscles of reparation (sternocleidomastoid and scale muscles of the neck) there may be a paradoxical pulse (a pulse that is weaker during inhalation and stronger during inhalation) over-inflation of the chest a blue color of the skin and nails, may occur from lack of oxygen in a mild exacerbated the peak exploratory flow rate (PEFR) is >= 200 l/min or >= 50% of the predicted best Moderate is defined as between 80 and 200 L/min r 25% and 50% of the predicted best

Nighttime symptom Intermittent <= 2/month Mild persistent 3-4/month Moderate persistent >1/week but nightly Severe persistent frequent (often 7x/week) Asthma is clinically classified according to: Frequency of symptom Forced exploratory volume in 1 sec (FEV1) Peak exploratory flow rate Classification according to degree of control:

SYMPTOMS ARE OFTEN WORSE At night In the early morning In response to exercise Cold air Some people with asthma only rarely experience symptoms, usually in response to triggers Other may have marked persistent airflow obstruction

high PaCO2 and or requiring mechanical ventilation Anyone of the following in a person w/ severe asthma: Life threatening asthma Measurements Peak flow < 33% Oxygen saturation < 92% PaO2 < 8 KPa normal PaCO2

Clinical Signs -altered level of consciousnes -exhaustion Arythmia Low blood pressure Cyanosis Silent chest Poor expiratory offer

Comes in episode with symptom-free periods in between May be worse at night or in early morning May go away on its own Gets better when using drugs that open the airways [bronchodilators] Gets worse when breathing in cold air Gets worse with exercise Gets worse with heartburn [reflux] Usually begins suddenly

GASTRO-ESOPHAGEAL REFLUX DISEASE Coexists with asthma in 80% with similar symptoms This is due to increased lunch pressures, promoting bronchoconstrictions, and through chronic aspiration SLEEP DISORDER due to altered anatomy of the respiratory tract: o increased upper airway adipose deposition o altered pharynx skeletal morphology o extension of the pharyngeal airway o leading to upper airway dispose CAUSE asthma is caused by environmental and genetic factors these factors influence how severe asthma is and how well it responds to modification the interaction is complex studying the prevalence of asthma and related disease such as eczema and hay fever have yielded important clues about some key risk factors the strongest risk factor for developing asthma is a history of atopic disease the increase ones risk of hay fever by up to 5x and the risk of asthma by 3-4x in children between the ages of 3-14, a positive skin test for allergies and an increase in immunoglobulin E increases the chance of having asthma in adults, the more allergens one reacts positively to in a skin test the higher the odds of giving asthma DIAGNOSIS severity of acute asthma exacerbations near-fatal asthma

History of any of the following: Cough, worse particularly at night Recurrent wheeze Recurrent difficulty in breathing Symptoms occur or worsen in the presence of: Exercise Viral infection Animals with fur or hair Mold Symptoms occur or worsen in the presence of: House-dust mites [in mattresses, upholstered furniture, pillows, carpets] Smoke [tobacco,wood] Pollen Changes in weather Differential Diagnosis

Acute Severe asthma Any one of Peak flow 33-50% Respiratory rate 25 breaths per minute Heart rate 110 beats per minute Unable to complete sentences in one breath Moderate asthma exacerbation Worsening symptoms Peak flow 80%-50% best or predicted No features of acute severe asthma Obstruction of the lumen of the bronchiole by mucoid exudate, goblet cell metaplasia, epithelial basement membrane thickening and severe inflammation of bronchiole in a patient with asthma There is currently not a precise physiologic, immunologic, or histologic test for diagnosing asthma The diagnosis is usually made based on the pattern of symptoms [airways obstruction and hyperresponsiveness] and/or response to therapy [partial or complete reversibility] over time Wheezing high-pitched whistling sounds when breathing outespecially in children [lack of wheezing and a normal chest examination do not exclude asthma

Differential diagnoses include: Infants and children o Upper airway diseases o Allergic rhinitis and sinusitis Obstruction involving large airways o Foreign body in trachea or bronchus o Vocal cord dysfunction o Vascular rings or laryngeal webs o Laryngotracheomalacia, tracheal stenosis, or bronchostenosis o Enlarged lymph nodes or tumor Obstruction involving small airways o Viral bronchiollitis or obliterative bronchiolitis o Heart disease o Other causes Management of Asthma

Wheezing which:

Specific treatment for asthma will be determined by physician based on: Age Overall health Medical history Extent of disease Tolerance for specific medications, procedures or therapies Expectations for the course of disease Opinion or preference -

o o

Know what to do when asthma gets worse Working with a healthcare professional is the best way to take care of asthma

The ff. is a list of things you can do to limit your exposure to common triggers of asthma; I. Allergies 1. Dust is the most common year round allergy. The allergy is caused by tiny insect-like creatures called dust mites. Dust mites are found in mattresses, carpets, and upholstered furniture. They thrive in warm, humid conditions and feed on the shed scales of human skin. The best way to prevent allergy symptpms caused by dust mites is to limit your exposure. Be sure to pay special attention to the bedroom where you spend the most amount of your time. a. Beds - Every bed in your house should have wooden or metal frames. - Do not sleep on a couch, sofa,or hidea-bed. -If your child has asthma and sleeps in a bunk bed, he/she should sleep in the top bunk.

There are specific guidelines for children from infants to 4 years old, 5 to 11 years old, and 12 and older The more information a person with asthma gas, the better asthma can be controlled

There is no cure for asthma Asthma can be often controlled with prescription medicines that may help to prevent or relieve symptoms, and by learning ways to manage episodes

Four Components of Asthma Treatment: 1. The use of objective measure of lung function spirometry peak flow expiratory flow rate 2. to access the severity of the asthma to monitor the course of the treatment

The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airway The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy Patient education that includes a partnership among the patient, family members and the physician b.

Managing Asthma People with asthma can learn to identify and avoid the things that trigger an episode Educate themselves about the medications and other asthma management strategies According to the most recent Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung, and Blood Institute: o o Asthma is a chronic illness It has to be cared for at all time not just when the symptoms are present

3.

4.

Mattress/box spring - Place all mattresses and box springs in a zippered, dust-proof cover and tape over the zippers with electrical or duct tape.

How to avoid asthma triggers: Many things can trigger an asthma episode, including the following: Upper respiratory infections Allergies to dust mites, pollens, animal dander, mold/mildew, or cockroaches Exercise Weather changes

c.

Pillows -Encase pillows in zippered, dust-proof covers. -Pillows should be made of Dacron or other synthetic fiber. -Do not use foam, feather, or Down pillows.

Four parts of continually managing asthma are: o o o Identify and minimize contract with asthma triggers

Understand and take medications as prescribed Monitor asthma to recognize signs when it is getting worse

Irritants such as cigarette and other forms of smoke, strong odors and perfumes,fumes from wood stoves or kerosene heaters, and air pollution

d. Bedding - Avoid wool or down blankets.

- Wash all bedding (sheets,pillowcases, blankets) in hot water. - Cold water will not kill the dust mites. - Dry all clothes and bedding in the dryer to avoid pollen sticking to them when on a clothesline.

- Cover all the furnace outlets in the room with special filters or cover the outlets with ten thickness of cheesecloth or muslin. - This will catch dust in furnace air. - Change the cheesecloth when it gets dusty underneath (about every two weeks) Test Arterial blood gas Chest X-ray Blood test to measure eosinophil count (a type of white blood cell) and IgE ( a type of immune system protein called immunoglobin) Lung Function Test

Specific medications for asthma are broadly classified into fast acting and long acting Bronchodilators are recommended for short term relief of symptoms. In those with occasional attacks, no other medication is needed.

e. Floor Covering - If possible, remove wall-to-wall carpeting. - If not, vacuum the carpet frequently (at least twice a week) or ask someone who does not have asthma to vacuum for you. - Substitute multi-layered vacuum bags for regular single layer bags. - Small, washable cotton rags may be used if washed often. - Wood, tile, or vinyl flowing w/o a rug is best, and they should be mopped at least weekly.

Medications o Medications to treat asthma are divided into two general classes:

1.

Quick relief medications used to treat acute symptoms. Long-term control medications used to prevent further exacerbation. If mild persistent disease is present (More than two attacks per week), low dose inhaled glucocorticiods or alternatively, an oral leukotriene antagonist or a mast cell stabilizer is recommended. For those who suffer daily attacks, a higher dose of inhaled glucocorticoids are added to these treatments. In a severe asthma exacerbation, oral glucocorticoids are added to these treatments.

2. Peak flow measurement

Treatment The goal of the treatment is to avoid the substance that trigger your symptoms and control airway inflammation. A specific, customize plan for proactively monitoring and managing symptoms should be created. Should work to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms. The most effective way to treat asthma is identifying triggers, such as cigarette smoke, pets, or aspirin, and eliminating exposure to them. If trigger avoidance is insufficient, medical treatment is recommended. Medical treatment used depends on the severity of illness and the frequency of symptoms. 1.

f. Closets -Remove all stored toys, bozes, and other articles from closets. - The closet should contain only clothing and should be as dust-free as the room. - Keep all clothes in closets, never lying around the room. g. Furnace (heating) -Electric or gas heat is recommended. - Do not use wood stoves or kerosene heaters. - Change the air filters on the furnace every month.

There are two kinds of medication for treating asthma:

Control drugs to prevent asthma

2.

Quick relief drugs for use during attacks.

Control drugs for asthma control your symptoms if you dont have mild asthma. You must take them every day for them to work. Take them even if you feel okay.

The most common control drugs are; 1. Inhaled corticosteroids- to keep your airway from swelling up Long acting beta-agonist inhalers also help asthma prevent asthma symptoms. Do not take long-acting beta agonist inhaler drugs alone.

2.

3.

Other control drugs that may be used are: Leukotriene inhibitors (such as SInguilair and Accolate) Omalizumab, which blocks a pathway that the immune system uses to trigger asthma symptoms.