Professional Documents
Culture Documents
ASTHMA
ASTHMA
ASTHMA
AKHILESH SINGH
MCE-PRIDE
LUCKNOW
1
Overview of Presentation
Introduction
Epidemiology of asthma
Pathophysiology
Diagnosis of asthma
Management of asthma
2
Introduction
Asthma
is a Greek word which means
breathless or
to breathe with open mouth
Asthma
No uniform agreement on the
definition of asthma.
Recurrent episodes
of
Airway obstruction is
Wheezing,
Breathlessness,
reversible
Chest tightness
either spontaneously
and
or with treatment
6
Coughing,
particularly at night
Busse et al. J Allergy Clin Immunol 2007.120, (5):S94-S138
or early morning
Epidemiology
Epidemiology
Global Burden of Asthma
Estimated 300 million patients worldwide with asthma
Global prevalence ranges from 1-18% of population in
different countries
WHO estimate 15 million Disability adjusted life
years (DALYs) are lost annually
Annual worldwide deaths from asthma estimated at
250,000
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
Epidemiology
Asthma morbidity in Asia*
Activity limitations in asthma patients
% of patients
with activity
limitations
Epidemiology
Prevalence in India
Estimates of prevalence rates of chronic asthma by age
(cases/ 100,000 persons)
Year
Locality
<15
years
15-59
years
60
years
and
above
2011
Urban
861
1865
8,628
Rural
1024
2615
11,747
Urban
874
1892
8,752
Rural
1039
2653
11,917
2016
(projected)
10
Epidemiology
Estimates of Economic burden
of asthma in India (Rs. in crores)
Year
Chronic
Acute
Total
1996
2001
2006
2011
2016
960.05
1543.74
2294.73
3197.60
4180.35
167.07
267.63
388.84
528.84
672.52
1127.12
1811.37
2683.57
3726.44
4852.86
(Estimated)
11
Pathophysiology of Asthma
12
Pathophysiology of Asthma
Airflow limitation caused by a variety of changes in airway
Bronchoconstrictionbronchial smooth muscle
contraction that quickly narrows airways in response to
exposure to a variety of stimuli, including allergens or
irritants.
Airway hyperresponsivenessan exaggerated
bronchoconstrictor response to stimuli.
Airway edemaas the disease becomes more persistent
and inflammation becomes more progressive, edema,
mucus hypersecretion, and formation of inspissatedmucus
plugs further limit airflow.
13
Pathophysiology of Asthma
Causes
Interplay between host factors (particularly genetics) and
environmental exposures
Genetics - Asthma has an inheritable component, but genetics
involved remain complex.
Innate immunity - Hygiene hypothesis
14
If yes,
If no,
TH1 response
and
lower incidence
of asthma
persistent TH2
response and
higher rates
of asthma
Continued
Environmental factors
Airborne allergens
Viral respiratory infections
Tobacco smoke
Air pollution (ozone and particulate matter),
Diet (obesity or low intake of antioxidants and
-3 fatty acids)
15
16
Diagnosis of Asthma
17
Diagnosis of asthma
Detailed medical history
Physical examination
Lung function testing: FEV1, FVC, PEF
Noninvasive markers of airway inflammation: FeNO,
FeCO, etc.
Measures of allergic status: Allergen skin test,
serum-IgE
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
19
Management of Asthma
20
Asthma treatments
Inhaled therapy: Drug delivered directly into
the airway, high local concentration, less
risk of systemic side effects.
Delivery of inhaled drug:
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
Asthma pharmacotherapy
Quick relievers: Act quickly to provide symptom relief,
bronchodilation, as needed basis.
Short acting inhaled beta 2-adrenoceptor agonists
(SABA): Salbutamol
Systemic glucocorticosteroids
Anticholinergics
Theophylline
Short acting oral beta 2-adrenoceptor agonists
22
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
Continued
Controllers: Long term basis, daily, antiinflammatory
effect.
Inhaled corticosteroids (ICS): Fluticasone, Budesonide,
beclomethasone propionate
Long acting inhaled beta 2-adrenoceptor agonists
(LABA): Salmeterol, Formoterol (never use as
monotherapy)
Theophylline
Leukotriene modifiers
Long acting oral beta 2-adrenoceptor agonists
Cromones
Anti-IgE (omalizumab)
Oral glucocorticosteroids
Allergen specific immunotherapy
23
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
Controlled
Daytime symptoms
None or (twice or
less/week)
>twice a week
Limitations of
activities
None
Any
Nocturnal symptoms
or awakening
None
Any
None or minimal
(twice or less/week)
>twice a week
Normal
Lung function
(FEV1 or PEF)
24
Uncontrolled
Three or more
features of partly
controlled asthma
present in any week
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
26
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
Patient education
27
Patient education
Patients should be educated about
Difference between relievers and controllers
Potential side effects of medications
Use of inhaler devices
Prevention of symptoms and attacks
Signs that suggest asthma is worsening and actions to
take
Monitoring control of asthma
How and when to seek medical attention
28
GINA Report, Global Strategy for Asthma Management and Prevention http://www.ginasthma.org/ accessed on 13/01/12
29
30
benefit to the patient outweighs the risk of systemic corticosteroid side-effects. African-American patients
may be at greater risk of serious respiratory-related events or deaths. Caution should be exercised when coadministered with strong CYP3A4 inhibitors (e.g. ketoconazole). Interactions: Avoid -blockers (unless
compelled to use). Inhibitors of P450 3A4 can produce great increase (ritonavir), minor increase
(ketoconazole), negligible increase (erythromycin) in systemic exposure to fluticasone propionate.
Ketoconazole can significantly increase plasma salmeterol exposure. Effects on Ability to Drive and Use
Machines: None noted. Pregnancy and Lactation: Use if the expected benefit to the mother is greater
than any possible risk to the foetus or child. Adverse Reactions: Paradoxical bronchospasm, tremor, cardiac
arrhythmias (atrial fibrillation, supraventricular tachycardia, extrasystoles), Cushings syndrome, Cushingoid
features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral
density, cataract and glaucoma. Common: muscle cramps, hoarseness/dysphonia, oropharyngeal irritation,
headache (transient, reduce with regular therapy), candidiasis (thrush) of the mouth and throat, palpitations,
pneumonia (in COPD patients).Uncommon: rash, contusions, cutaneous hypersensitivity reactions. Rare:
hypersensitivity reactions (angioedema, mainly facial and oropharyngeal oedema), respiratory symptoms
(dyspnoea and/or bronchospasm). Very rare: arthralgia, hypersensitivity reactions (anaphylactic reactions
such as oedema, angioedema, bronchospasm, anaphylactic shock), hyperglycemia, anxiety, sleep disorders
and behavioural changes, including hyperactivity and irritability (predominantly in children). Overdosage:
Salmeterol: Tremor, headache, tachycardia, increases in systolic blood pressure and hypokalaemia.
Antidote: Cardioselective -blocking agents, use with caution in patients with a history of bronchospasm. If
Seretide needs to be withdrawn, provide appropriate replacement corticosteroid therapy. Fluticasone
propionate: May lead to temporary suppression of the hypothalamic-pituitary-adrenal axis, does not usually
require emergency action as normal adrenal function typically recovers within a few days.
Salmeterol/Fluticasone propionate: If higher than approved doses are continued over prolonged periods,
significant adrenocortical suppression is possible. Very rare reports of acute adrenal crisis (potential triggers:
trauma, surgery, infection or any rapid reduction in the dosage of the inhaled fluticasone propionate
component) mainly in children exposed to higher than approved doses over prolonged periods (several
months or years). Observed features include hypoglycaemia associated with decreased consciousness and/or
convulsions. Patients should not receive higher than approved doses of Seretide. Review therapy regularly
and titrate down to the lowest approved dose at which effective control of disease is maintained.
Refer to full prescribing information before use.
Full
prescribing information available on request from GlaxoSmithKline Pharmaceuticals Ltd., Dr. Annie
Besant Road, Worli, Mumbai- 400030.
Version: SER/API/IN/2009/01 v02 dated 15 June 2011
31
IN/SFC/0029/12