Asthma

BRONCHIAL
ASTHMA
Bronchial asthma
A chronic obstructive disorder of the airways


characterized by bronchospasm and

inflammation, which occur in response to a
variety of stimuli

a chronic inﬂammatory condition with reversible
airways obstruction.

It is characterized by recurrent episodes of
wheezing, often with cough, which respond to
treatment with bronchodilators and anti-
inﬂammatory drugs.

Symptoms may be reversible spontaneously or
Wheeze
Wheeze is a high-pitched whistling sound
on expiration.
It is caused by spasmodic narrowing of the
distal airway.
To hear a wheeze, even in mild cases, place
your ear next to the child’s mouth and listen
to the breathing while the child is calm, or
use a stethoscope
Epidemiology
In 2009, 300 million people worldwide were
affected by asthma leading to approximately
250,000 deaths per year.
It is estimated that asthma has a 7-10%
prevalence worldwide.
 Asthma prevalence correlates well with
reported allergic rhino conjunctivitis and atopic
eczema prevalence.
 Approximately 80% of asthmatics report
disease onset before 6 years of age
Risk factors
 Family history.
 coexisting atopy.
 Male sex.
 Parental smoking.
 Hospitalized for bronchiolitis in infancy
Triggering factors
 Allergens/irritants.
 Cold weather.
 Dust
 Exercise
 Stress
 Infection of the upper air way
Clinical presentation and diagnosis
 It can be asymptomatic (a person rarely

experience symptoms) if present are usually in
response to triggers.
 Common symptoms of asthma include
 wheezing,
 shortness of breath,
 chest tightness and
 coughing.
 Symptoms are often worse at night or in the

early morning, or in response to exercise or
cold air.
Clinical presentation
 Acute episode may start with a trigger.
 Tight non productive cough initially.
 Wheezing and dyspnoea with prolonged

expiration.
 Hyper inflation of the chest which may be

clinically detected by an increased anterior-
posterior diameter of the chest(barrel shaped
Clinical diagnosis can be made by:-
 Family history of asthma or atopic

dermatitis or allergic rhinitis.
 Three or more episodes of reversible
airway obstruction.
 Relatively afebrile episodes mild fever
may be present after the onset of cough

and wheeze and it is due to exertion
associated with dyspnea.
 Presence of trigger factors precipitating
the episodes.
physical examination
 During acute episodes Patient will present

with; tachypnea, tachycardia, cough, wheezing,
and a prolonged expiratory phase.
 As the attack progresses;
cyanosis, diminished air movement (tight
chest), retractions, agitation, inability to speak,
tripod sitting position, diaphoresis, and pulsus
paradoxus (decrease in blood pressure with
inspiration of >15 mm Hg) may be observed.
 Physical examination may show evidence of
other atopic diseases, such as eczema or
Tripod sitting position
Patients with ad-
vanced lung dis-
ease (in this case
COPD) will often
assume a tripod
position
(leaning forward,
hands on knees)
when breathing
difficulties occur.
This provides a
position that
optimizes respira-
tory mechanics.
Investigation
 Lung function test.
 Allergy skin testing.
 A chest radiograph (CXR) should be
performed with the first episode of asthma to
exclude anatomic abnormalities.
- Children with a history of asthma do not need
repeat chest radiograph with each episode,
unless there is fever that suggests pneumonia,
or if there are localized findings on physical
examination.
 FBP
Differential diagnosis
 Viral bronchiolitis or other pulmonary infection

 Aspiration
 Air flow obstruction
- Laryngotracheomalacia
- Vascular ring,
- Airway stenosis
- Mediastinal mass
- Foreign body
-Vocal cord dysfunction
 Bronchopulmonary dysplasia, obliterative bronchiolitis
 Chronic congestive heart failure with ‘cardiac asthma’
ASTHMA MANAGEMENT
Triage
Outpatient (mild/moderate: no hypoxia,
no fever, mild respiratory distress, no co-
morbidities, good social support )
Inpatient (severe: cannot complete whole
sentences, RR>25, pulse>110, co-morbid
conditions )
ICU (life threatening: RR>40, O2<90% or
cyanosis, altered mental status, silent
chest or feeble respiratory effort)
The following should be given immediately
for all patients during interview:
 Salbutamol inhaler 2 puffs once and then every 30 minutes

until the patient has received at least three doses
 T.Prednisolone 2mg/kg x 5/7 (max 60mg) or
IV hydrocortisone 100mg 6 hourly x 1/7 if unable to take
PO
 If Salbutamol is not available, consider IV aminophylline at
an initial loading dose of 5–6 mg/kg (up to a maximum of 300
mg) over at least 20 min but preferably over 1 h, followed by
a maintenance dose of 5 mg/kg every 6 h.
 If febrile asthma or COPD exacerbation: start Ciprofloxacin
or Azithromycin x 5/7
 Reassess the patient every hour for resolution of symptoms
 Triage appropriately based on response to medications.
Avoid sedatives.
SUPPORTIVE CARE
Daily maintenance fluids according to
his/her age
Encourage BF and oral fluids
Encourage complementary feeding
NGT
O2
Metered dose inhaler
STATUS ASTHMATICUS
Progressive respiratory failure due to asthma
where conventional forms of therapy have
failed.
Acute severe Life threatening
Too breathless to talk or feed Cyanosis

Respiratory rate > 50 breaths/min Silent chest
Pulse rate > 140/min Fatigue

Peak expiratory flow < 50% PEF < 33% predicted or best
MANAGEMENT OF S.
ASTHMATICUS
 Drugs
 In respiratory arrest give oxygen therapy
IV b2-agonist therapy with agents such as
salbutamol (initial loading dose 1mcg/kg/min
for 10 min then continuous infusion
0.2mcg/kg/min) this dose can be increased by
0.1mcg/kg after every 15min depending on
response.
IV corticosteroids such as hydrocortisone
2-4 mg/kg
COMPLICATIONS OF
ASTHMA.
With acute asthma, complications are
primarily related to hypoxemia and acidosis
and can include generalized seizures.
In status asthmaticus, the associated
Complications include;-
.Pneumomediastinum
.Pneumothorax
Complications cont.
loss of pulmonary function with
persistent airway inflammation.
Childhood asthma independent of any
corticosteroid therapy has been shown to
be associated with delayed maturation
and slowing of prepubertal growth
velocity.
PREVENTION
 Strict avoidance of the causative agent is
extremely important.
 An effort to determine its cause should be
made, beginning with a thorough history.
 Typically there is a strong temporal
relationship between exposure and onset of
symptoms.
 With exercise-induced anaphylaxis, patients
should be instructed to exercise with another
person and to stop exercising at the first sign of
symptoms. If prior ingestion of food has been

Asthma

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BRONCHIAL

A chronic obstructive disorder of the airways

characterized by bronchospasm and

 It can be asymptomatic (a person rarely

 chest tightness and

 Symptoms are often worse at night or in the

 Tight non productive cough initially.

 Wheezing and dyspnoea with prolonged

 Hyper inflation of the chest which may be

 Family history of asthma or atopic

may be present after the onset of cough

 During acute episodes Patient will present

 Viral bronchiolitis or other pulmonary infection

 Salbutamol inhaler 2 puffs once and then every 30 minutes

Acute severe Life threatening

Too breathless to talk or feed Cyanosis

Pulse rate > 140/min Fatigue

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