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INTRODUCTION
EPIDEMIOLOGY
AETIOLOGY
This can also occur in certain patients with chronic bronchitis and
allergic rhinitis but usually to a lesser extent.
One of the most common trigger factors is the allergen found in the
house dust mite.
Allergens
Pollens,moulds,house dust mite, animals
Industrial chemicals
Isocyanate containing paints, epoxy resins,aluminium,hair sprays.
CONT
Drugs
Aspirin, ibuprofen and other prostaglandin synthetase
inhibitors, beta blockers.
Foods
nuts, fish, sea food, dairy products, food colouring.
Other industrial chemicals
Wood or grain dust, cotton dust, cigarette etc
Miscellaneous
Cold, exercise, hyperventilation ,viral respiratory tract
infections, emotion or stress.
TYPES OF ASTHMA
Extrinsic Asthma
Intrinsic Asthma
Atopic asthma
Hereditary predisposition
Personal history of allergic
Starts early in life
Serum IgE levels
Symptoms may be seasonal or
perennial
Responds to corticosteroids
Idiopathic or cryptogenic
No hereditary predisposition
No history of allergies rhinitis,
atopic dermatitis
Starts late in life
Serum IgE levels are normal
Symptoms are perennial
Responds to corticosteroids
PATHOPHYSIOLOGY
CONT
CLINICAL MANIFESTATIONS
Chronic Asthma
Acute Asthma
Airway eodema
Excessive mucus acumulation
Complain of severe dyspnea
Chest tightness or burning
Expiratory and inspiratory
wheezing on auscultation
Tachycardia,tachypnea
Pallor or cynanosis
DIAGNOSIS
Skin test
CONT
TREATMENT
Reducing inflammation
Increasing bronchodilation
Restoration of normal airways function
Prevention of severe acute attacks
Avoidance of recognized trigger factors
CHRONIC ASTHMA
The pharmacological management of asthma depends upon the
frequency and severity of patients symptoms.
I.
Sympathomimetics
2 adrenergic receptor stimulation activates adenyl cyclase,
which produce an increase in intracellular cAMP. This cause
relaxation of bronchial smooth muscles and bronchodilation
Short acting agents
Salbutamol 2-4mg
Inh. 100-200g 3-4 times daily
Terbutaline 5-10mg
Long acting agents
Inh. Salmeterol 25g bid
Inh. Formeterol 12-24g bid
Prednisolone-40-60mg
Inh. Beclomethasone 100-400g in 2 div doses
Inh. Budesonide 200-800g in 2 div doses
Inh. Fluticasone 200-500g in 2 div doses
IV Anticholinergic
They are competitive inhibitors of muscarnic
receptors:they produce bronchodilation only in cholinergic
madiated bronchoconstriction.
Ipratropium bromide-500mcg repeated as necessary
V leukotriene antagonist
CONT
VII Anti IgE Antibodies
Cont
Step 4-persistent poor control.
increase steroid upto 2000mcg/day-PLUS LRA,sr
theophylline,B2 agoinist tablet.
Step-5-continous of frequent use of oral steroid
Use daily steroids tablet in lowest dose providing adequate
control.
ACUTE ASTHMA
Main aim is to relieve airflow obstruction and hypoxaemia as quickly as
possible and to plan prevention in future relapses.
Immediate management
inhalation 4L/min to maintain spo2>90%
High concentration of oxygen(humidified if possible)
short
Cont
Subsequent management
If patient fail to improve
Inj magnesium sulphate 40mg/kg in 50ml 5%dextrose as slow
infusion over 20 minutes.
Inj aminophylline 5mg/kg slowly followed by 0.8-1.2mg/kg/hr
slow infusion.
If aminophylline is given then monitor the serum concentration of
aminophylline(therapeutic range 10-20ug/ml)
REFERENCES
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