Asthma Treatment

1
Asthma Treatment

• James Smith, D.O.
• 11/24/2005

2
Chief Complaint and History

• CC Patient come to the office c/o continued SOB,
  wheezing, and nocturnal cough.
• HPI Patient is a known asthmatic who is on
  maximum treatment for chronic persistent asthma
  yet still has above complaints. He notes that
  symptoms are worse when he is out in the cold
  weather.

3
Physical Exam

• Gen Mild respiratory distress with noted
  accessory muscle use.
• Heart RRR. No murmurs
• Resp Decreased air movement in all lung fields.
  Expiratory wheezes noted throughout.
• MS Increased sub-occipital fullness. Increased
  cervical and scalene muscle tension. C4 F Rl Sl.
  Inhalation 1st rib on right. T2 F Sr Rr with
  right 2nd rib posterior.

4

• MS (Cont.) Decreased overall compliance of
  inspiratory effort of rib cage. Increased
  diaphragm tension with some flattening. L3-4 E Sr
  Rr.
• To further understand some of these findings lets
  review some of the corresponding anatomical
  relationships.

5
Functional Anatomy

• C-spine OA, AA, C3-C5, and scalene muscles
• T-spine and CV joints paraspinal sympathetic
  ganglia
• Rib cage compliance and respiratory function
• Thoracoabdominal diaphragm
• L-spine compensation and relationship to
  diaphragm

6
C-spine OA , AA, C3-C5, and scalene muscles

• Vagus nerve path through OA and AA
• C3-C5 and Phrenic nerve origin
• Scalene attachment to 1st and 2nd ribs

7
T-spine and CV joints paraspinal sympathetic
ganglia

• Sympathetic chain gaglion
• Vertebra and rib association
• Posterior rib angles position for fulcrum

8
Rib cage compliance and respiratory function

• Complex neuromuscular association
• Cervical and scalene muscle attachments
• Nerovascular complex and congestion

9
Thoracoabdominal diaphragm

• Convex dome shape
• Costal attachment of edges
• Lumbar attachment of the crual muscles
• Phrenic nerve inervation
• Vascular/Lymphatic openings

10
L-spine compensation and relationship to
diaphragm

• Crual muscle origin and attachment to lumbar
  spine
• Lumbar spine fascia and integration with
  diaphragm fascia

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Expected Results

• Normalizing Parasympathetic/sympathetic tone
• Increase of the following
• Acute burst of catecholamines and bronchial
  dilation
• Thinning of my secretions
• Decrease of the following
• Goblet cell hyperplasia over the long term
• Smooth muscle hyperplasia over the long term
• Quantity of mucus production

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• Improving diaphragmatic motion
• Allowing for increased tidal volume
• Improving lymphatic flow and decreasing vascular
  congestion
• Improving thoracic cage compliance
• Increases AP diameter and overall respiratory
  excursion
• Decreases muscle and fascial tension allowing for
  neurovascular imrpovement

13

• Improve/Normalize vagus and phrenic nerve
  involvement.
• Decreases mucus production and bronchial spasm
• Improves neural stimulation of the diaphragm
• Correct lumbar spine compensations
• Decreases tension into diaphragm via crual
  muscles
• Maintain natural lumbar lordosis improving
  thoracoabdominal mechanics for respiration

14
Possible Treatments

• S-O release, OA and AA treatment
• ME for C3-C5 dysfunction
• Soft tissue stretching of scalene muscles
• Correction of 1st rib dysfunction
• Asthma reflex at T2 on left (if rib involved
  inhibitory pressure works well)

15
Possible Treatments

• Rib raising (seated or supine)
• Increase thoracic cage compliance
• Abdominal diaphragm redoming
• HVLA for lumbar compensation

16
S-O release

• Patient supine
• Place finger tips at base
• of occiput
• Apply anterior pressure
• Allow head to extend over fingers stretching the
  diaphragm
• Ask patient to take several deep breaths in and
  out
• Repeat monitoring for a release

17
Soft tissue stretching of paraspinal and
scalene muscles

• Cross hands allowing head to rest on them
• Flex head and have patient push head back into
  them
• Apply one hand to head and other to 1st and 2nd
  rib area.
• Sidebend head away and have patient push back
  towards shoulder

18
OA and AA treatment

• Patient supine
• Evaluate for rotation and sidebending
  restrictions
• Take patient to restriction barriers, flex head
  to 40 degrees
• Ask patient to turn back to ease
• Have patient relax and take patient to a new
  restrictive barrier
• Repeat series 3 times monitoring for release

19
ME for C3-C5 dysfunction

• Patient supine
• Like AA and OA take patient to restrictive
  barrier
• Do not flex head to 40 degrees
• Ask patient to turn head back into ease
• Have patient relax and take to new restrictive
  barrier
• Repeat cycle 3 times monitoring for release

20
Correction of 1st rib dysfunction

• Apply direct contact
• to 1st rib head
• May apply to one
• rib or both at the
• same time
• Apply direct pressure
• caudad and ask patient to shrug shoulders
  upwards
• During this have patient take a deep breath in
• Repeat upto 3 times or until release is felt

21
Rib raising (supine)

• Patient supine
• Contact posterior
• rib angles with fingertips
• Apply anterior
• pressure with lateral traction
• Continue and monitor for muscle tension release

22
Abdominal diaphragm redoming

• Patient is supine
• Place hands at the base of the ribs
• Place thumbs under costal margin
• Have patient take a breath in and resist
• Have patient exhale and follow diaphragm up
• Keep thumbs inplace and have patient take another
  breath

23
HVLA for lumbar compensation

• Lay patient in left lateral recumbent position
• Extend or flex from below to level of dysfunction
• Rotate and sidebend patient from above down to
  level of dysfunction
• Apply rotational thrust through innominant in a
  anterior and inferior motion
• Recheck when finished