Transcript Bronchial Astma
Prepared by: Ibrahim Tawhari.
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.
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
endogenous or exogenous stimuli.
to
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%
PATHOPHYSIOLOGY: During an acute asthmatic attack: Airways obstruction V/Q mismatch Hypoxemia Hyperventilation PCO2 PH (Respiratory Alkalosis)
PATHOPHYSIOLOGY: Muscle Fatigue Ventilation PCO2 PH (Respiratoty Acidosis)
TRIGGERS
TRIGGERS: URTIs.
Allergens / Irritants: Pet dander House Dust Mould Pollens Feather Smoking Air Pollution
TRIGGERS: Drugs: Aspirin Emotion & Anxiety: NSAIDs -Blockers
TRIGGERS: Others: Cold Air Exercises GERD
SIGNS & SYMPTOMS…
SYMPTOMS & SIGNS: Tachypnea, Wheezing, Chest tightness, Cough (especially nocturnal), sputum production.
RED FLAGS…
RED FLAGS: Fatigue Silent Chest Expiratory Effort Cyanosis LOC
Respiratory Distress: Nasal flaring, tracheal tug Inability to speak Accessory muscle use, intercostal indrawing Pulsus paradoxus
DIAGNOSIS
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…
DIAGNOSIS:
History:
Atopic manifestation: Atopy Triad
DIAGNOSIS:
P/E:
General Appearance, Vital signs:
Tachypnea, pulsus paradoxus, fever,…???
General Examination: Cyanosis, eczema, nasal polyps, URTI, … Local Examinations: Inspection: Palpation: Auscultation: Percussion
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…
DIAGNOSIS:
Investigations:
PFTs: Spirometry: FEV1: Improvement with medications..
MANAGEMENT
Management:
Non-Pharmacologic Management:
Avoid allergens… Education of the patient: Features of disease… Goal of management… How to do self monitoring… Red flags…
Management:
Pharmacologic Management:
Symptomatic relief in ACUTE ATTACKS: Short acting 2-agonists: albuterol, terbutalin, mataprotrenol,… Anticholinergic bronchodilators… Steroids… Long acting 2-agonists: Salmetrol, formetrol,…
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,..
Management:
FOLLOW UP
Criteria of Controlled Asthma:
Assessment of Control:
THE END….