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BRONCHIAL ASTHMA

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Asthma is a chronic inflammatory disorder of the airways in ... Spirometric function. Severe cases - daily symptoms - nocturnal or morning symptoms once/week ... – PowerPoint PPT presentation

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Title: BRONCHIAL ASTHMA


1
BRONCHIAL ASTHMA
  • DR. P. E. ABRAHAM
  • CONSULTANT PHYSICIAN ALLERGY SPECIALIST

2
Introduction
  • Definition
  • Asthma is a chronic inflammatory disorder of the
    airways in which many cells and cellular elements
    play a role, in particular mast cells,
    eosinophils, T.Lymphocytes, macrophages,
    neutrophils and epithelial cells

3
Introduction contd
  • In susceptible individuals this inflammation
    causes recurrent episodes of wheezing,
    breathlessness, chest tightness and coughing,
    particularly at night or in the early morning.
  • These episodes are usually associated with wide
    spread but variable airflow obstruction that is
    often reversible, either spontaneously
  • The inflammation also causes an associated
    increase in the existing bronchial
    hyper-responsiveness to a variety of stimuli
  • Prevalence up to 20 in children
  • low in teen ages
  • 5-10 of adults

4
History
  • Intermittency
  • Triggers ( aeroallergens, exercise, cold air,
    food)
  • Age of onset
  • Relief by broncho-dilators
  • Nocturnal or early morning symptoms

5
Diagnosis
  • History alone
  • History peak flow variables
  • History spirometry broncho-dialtor
    response
  • History airway responsiveness

6
Differential diagnosis
  • Post nasal drip
  • Upper airway dysfunction
  • Goitre
  • Broncho-malacia
  • Vocal cord dysfunction
  • Hyper-ventilation syndrome
  • Obesity

7
Risk factors associated with childhood asthma
  • Family history
  • Atopy
  • Diet low omega-3 fatty acid in diet
  • Breast fed lt 3 months
  • GENETICS

8
Investigations
  • Spirometry
  • -Obstruction at base line
  • - FEV1/FVC ratio less than 80
  • -Broncho-dilator reversibility
  • Peak-flow meter
  • -At home monitoring
  • -Diagnosis, control monitoring
  • -Blood test, culture and sensitivity of sputum

9
Mechanical consequences of acute asthma
  • Airway narrowing
  • Hyperinflation
  • Airway closer
  • Bronchial challenge testing Direct
  • Indirect

10
Airway hyper-responsiveness
  • Characteristic abnormality of asthma
  • Ability of the airways to narrow too easily and
    by too much
  • Non-specific
  • Asthma
  • COPD
  • Allergy
  • Normal
  • LVF

11
MANAGEMENT
  • Six step asthma management plan
  • Asses severity
  • Achieve best lung function
  • Avoid trigger factors
  • Optimize medication programme
  • Develop an action plan
  • Regular review and education

12
Severity or control assessment
  • Symptoms
  • Symptom frequency and nocturnal asthma
  • Morbidity. Eg. Hospitalisation and exacerbation
  • Broncho-dilator use
  • Peak-flow variability
  • Spirometric function

13
Severe cases
  • - daily symptoms
  • - nocturnal or morning symptoms gt once/week
  • - usually a hospital admission in last 12 months
  • /- IPD admission
  • - FEV1 lt 60 of predicted
  • - waking PEF lt 80 best

14
Mild cases
  • - occasional symptoms
  • - no nocturnal or morning symptoms, hospital
    visits in last 12 months, ICU admission
  • - broncho-dilator use lt 2/week
  • - FEV1 gt 80 of predicted
  • - waking PEF gt 90 recent best.

15
Inhaled cortico-steroid treatment
  • Prevention
  • Dose of steroids
  • Mild to moderate
  • 750/1000 mEq/day of beclomethasone or 800
    mEq/day of Budesenide beta-agonist when
    required
  • Severe asthma
  • up to 2000 mEq/day Ist, 2400 mEq/day second
  • 500 1000 mEq/ day of Fluticasone propionate
  • Side effect of Steroid therapy Growth delayed

16
Asthma in pregnancy
  • Exacerbations are most frequent between 24 and 36
    weeks.
  • Exacerbation during delivery are very uncommon
  • Problems in pregnancy due to asthma
  • Pre-eclamsia more incidence (2-3)
  • Perinatal mortality ( 2 times)
  • Pre-term birth ( 30 times) more with steroid
    treated case.
  • low birth weight
  • increased incidence congenital malformation

17
Summary of Asthma in pregnancy
  • treat the asthma
  • associated with better foetal outcome
  • drugs are safe and effective
  • benefits of good treatment outweigh the risk of
    under treatment

18
Allergic Broncho-Pulmonary Aspergillosis (ABPA)
  • History asthma
  • Immediate skin test reactivity to aspergillus
    antigen
  • Preciopitating serum antibody to antifungative
  • Proximal bronchiectasis
  • Serum total IgE gt 1000 ng/ml
  • Peripheral blood eosinoplils lt 500/cu mm.
  • Elevated IgE and IgG to antifungative.
  • Lung infiltrates.

19
Aspirin Sensitive Asthma
  • may be non-atopic
  • often severe asthma
  • sensitivity to dietary salicylates
  • fresh fruits
  • vegetables
  • Samters triad
  • - Asthma
  • - Aspirin intolerance
  • - Nasal polyp

20
Occupational asthma
  • Isocynates, formaldehyde anhydrides
  • Plicatic acid Carpenters
  • Plant products Bakers
  • Animal proteins
  • Latex
  • Pollution fumes
  • House dust mites allergens avoidance
  • controversial
  • efficacy ??
  • effective if able to reduce HDM levels lt 3
    mEg/gm
  • best

21
My observations in management of asthma for the
past 30 years
  • Adult asthma
  • Childhood asthma
  • My management programme
  • 4 pillars
  • - Diet (50)
  • - Homoeopathy
  • - Yoga therapy
  • - Vita-nutrient therapy

22
Dietary management of Asthma
  • Triggers
  • Source for infection (bronchitis)
  • Immunity involvement Sugar
  • Night aggravation
  • Obesity
  • Alkaline and acid food

23
Summary of my observations
  • Most of the asthma is curable
  • - childhood 90 99
  • - adult 80 90
  • Definition of cure
  • Definition of Optimum health
  • It is the fundamental right of every individual
    to take full favour from the nature and as
    physicians it is our duty to provide the facility
    for the same

24
THANK YOU
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