ASTHMASarang Suresh Hotchandani

Final Year Bachelor in Dental Surgery (BDS) Student@ Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, Pakistan

INTRODUCTION

• It is obstructive pulmonary disease.

•Defined as chronic inflammatory disorder of airways characterized by airway hyper responsiveness and airflow obstruction leading to recurrent episodes of coughing, wheezing, breathlessness & chest tightness…

ETIOLOGY

1)Airway Hyperactivity• It is tendency of airway to narrow in response to

triggers that have little or no effect in normal individuals.• Causes of airway hyperactivity• Airway inflammation• Degree of airway narrowing• Neurogenic mechanisms

ETIOLOGY cont’d

2) Atopy/Allergy•Atopy is defined as ability to rapidly produce IgG against materials.

COMMON ALLERGENS

Indoor and outdoor allergyMicrobial exposureDietBreast feedingVitaminsPetsHouse dustFungiWeather changeDrugs

Aspirin & B-Blocker (Propranolol)Exercise

PATHOPSIOLOGY

•Inhalation of an allergen into airway is followed by early & late Broncho constrictor response.

EARLY OR IMMEDIATE BRONCHO CONSTRICTOR RESPONSE

•Occurs shortly after exposure to allergen within first 15 min - 1hour.

• Caused by mediators of immediate hypersensitivity reaction; mast cells/basophils, release mediators and causes inflammation that leads to airway hyperactivity.

LATE BRONCHO CONSTRICTOR RESPONSE

•Occurs late after exposure to allergen about 4-6 hours after.

•Caused by influx of inflammatory cells and then releasing mediators which causes inflammation which leads to airway hyperactivity.

NOTE...NSAIDS release leukotrienes which causes asthma.

Exercise cause loss of water from respiratory mucosa due to hyperventilation which triggers mediator release.

Remodeling of airway

Fixed narrowing of airway

Fibrosis

COMPLICATIONS OF ASTHMA

CLINICAL FEATURES OF ASTHMA

Wheezing

Chest Tightness

Breathlessness

COUGH

• Daily, Throughout Day

• Asthma Attack Daily• Not Throughout Day

• Greater Than 2 Days/Week

• Not Daily

• Asthma Attack• Less Than 2

Days/Week

Intermitten

tMild

Persistent

Sever Persistent

Moderate Persistent

Classifi

catio

n Asthma

DIAGNOSIS OF ASTHMA

“

”

DIAGNOSIS IS PREDOMINATELY CLINICAL

• Clinical History• Demonstration of airflow obstruction by using spirometry or peak

flow meter.• If•FEV ≥15% increases after administration of bronchodilator, Asthma is present.

•> 20% diurnal variation on ≥ 3 days in week for 2 weeks on PEF, Asthma is present.

•FEV ≥ 15% decrease after 6 min exercise, Asthma is present.

OTHER INVESTIGATIONS

• Measurement of allergic status

• Presence of atopy by skin prick test

• Measurement of Ig E

• FBC, for eosinophilia

• Radiological exam

• CXR often normal or show hyperinflation of lung.

MANAGEMENT

•STEP 1•STEP 2•STEP 3•STEP 4•STEP 5

STEP 1•Occasional use of inhaled short acting B2 – adrenal receptor agonist bronchodilators • E.g. Salbutamol, Terbutaline (in mild intermittent asthma)

STEP 2

Anti inflammato

ryTherapy

Inhaled short acting

beta agonist

Asthma Control

Anti inflammatory = Inhaled corticosteroids; Budesonide, Fluticasone & Baclometason

STEP 3 (add on Therapy)• Change short acting beta agonist with long acting beta

agonist(LABA).

InhaledCorticosteroi

ds

Long ActingBeta

agonists

STEP 4 (Addition of 4th Drug)

• Used in those whose poor control on moderate dose of inhaled corticosteroid & LABA.• Discontinue the LABA from ICS and give any of following.

Leukotriene receptor antagonist

Theophylline

Slow release B2–

agonist

STEP 5• continues use of oral steroids for control of

symptoms• Osteoporosis caused by corticosteroid can be prevented

by giving bisphosphonates.

• In atopic Patients, omalizumab (monoclonal antibody directed against I g E.

• Note: once asthma is controlled slowly reduce dose of corticosteroids.

EXACERBATION OF ASTHMA causes

•Viral and fungal infection•Pollens•Air pollution

Management of MILD to MODERATE Asthma

•Short course of rescue oral corticosteroid•(Prednisolone 30-60 mg daily)

Management of STATUS ASTHAMATICUS (Features)

•PEF = 33-50%•Respiratory Rate ≥ 25 breaths/minute•Heart rate ≥ 110 beats/minute•Inability to complete sentence in one breath

TREATMENT OF STATUS ASTHAMATICUS

•Oxygenation (O2 saturation should be > 92%)•High dose inhaled bronchodilators• SHORT ACTING B2 AGONIST ARE DRUG OF CHOICE• Salbutamol• Ipratropium bromide

• Systemic corticosteroids • Orally; Prednisolone• IV; Hydrocostisone

Still No Response….

Go for INTUBATION

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