Asthma

• Is defined as a recurrent, episodic shortness of

breath caused by bronchoconstriction arising
from airway
- inflammation
-hyperreactivity.
 Symptom signs of Asthma
• coughing
• shortness of breath
• chest tightness
• wheezing.
• Asthma symptoms are produced by

-reversible narrowing of the airway,

 RISK FACTORS
• In mild asthma, symptoms occur only
occasionally,
• eg, on exposure to allergens or certain
pollutants,
• on exercise, or
• after a viral upper respiratory infection.
 Three factors contribute to airway obstruction in asthma:

• (1) Contraction of the smooth muscle that

surrounds the airways;
• (2) Excessive secretion of mucus and in some,
secretion of thick, tenacious mucus that
adheres to the walls of the airways; and
• (3) Edema of the respiratory mucosa.
 Trigger factors for Asthma

• Smoking:- is the major trigger

• Respiratory infection
 Allergens:-
• Airborne pollens (grass, trees, weeds)
• house-dust mites
• animal danders
• Cockroaches
• fungal spores
 Environment:-

 Cold air
 Fog
 Ozone
 sulfur dioxide
 nitrogen dioxide
 tobacco smoke
 wood smoke
 Emotions:-

-Anxiety
-stress
-laughter
 Exercise:-

-Particularly in cold
-dry climate
 Drugs/preservatives:-

• -NSAIDs (cyclooxygenase inhibitors like

ibuprofen, aspirin),
-sulfites
-β-blockers

• Occupational stimuli
• The sxs of asthma consists of/triads of asthma
 SOB
 Chest thightness
 Wheezing

Cough that produces thick tenicious sputum

-worse particularly at night
- Tenacious mucus-difficult to expectorate-

- Symptoms occur or worsen at night-

- Tachypnea (fast breathing)- Wheeze/Rhonchi-

- Use of accessory muscles of respiration

• Wheezing- high-pitched whistling sounds
during expiration. Wheezes areusually
recurrent.
• However, moresevere forms of asthma are
associated with frequent attacks of
-wheezing
-dyspnea(especially atnight)
-Chets Thightness
 Danger signs during acute attacks: -
-Paradoxical breathing
- Profound diaphoresis
- Cyanosis
– Exhaustion Arrhythmia
- Silent chest on auscultation
- Drowsiness or confusion
- Agitation
- SPO2 < 90 %
• Physical examination;
general appearance:
alteration of consciousness
 fatigue
upright posture
 diaphoresis
• Respiratory system
 tachypnea (>30\min)
 use of accessory muscles for breathing
over inflation of the chest, reduced
respiratory excursion, diffuse expiratory
wheezing
 Investigation

• SPIROMETRY
PEFR<120L/min
FEV1<1L
Arterial blood gas analysis
hypercapnia or normal
CXR: over inflated lung
 Treatment

Objectives
- Prevent respiratory failure
- Relieve symptoms promptly
- Shorten hospital stay
 Non-pharmacologic
1. Hospital admission-Admit patients with any
feature of a severe attack persisting after
initial treatment in the emergency room to
wards.
• Admit patients with life threatening attacks
directly to ICU.
• 2. Oxygen-give supplementary oxygen via face
mask or nasal cannula to all hypoxic patients
with acute asthma to maintain a SpO2 level of
>90%. Lack of pulse oximetry should not
prevent the use of oxygen.
• 3. Positioning-sitting upright and/or leaning.
• 4. Hydration-most patients need IV hydration.
 Pharmacologic
First line
• Salbutamol: 6 to 8 puffs every 20 minutes in the
first 1-4 hours.

• Then the same dose every 1-4 hours depending

on the patient need.
 Bronchodilators
• PLUS Ipratropium bromide, 4–8 puffs every 20
minutes as needed up to 3 hours, 0.25– 0.5mg
every 20 minutes for 3 doses, then as needed
• OR Aminophylline, IV 250mg IV bolus slowly
over 20 minutes Maintenance:
0.5mg/kg/hour (maximum: 900mg/day).
• For patients cardiac decompensation, cor
pulmonale, hepatic dysfunction, Multiorgan
dysfunction decrease dose by 50%.
• Old patients (>60 years): 0.38 mg/kg/hour
(maximum: 400mg/day)
• Adrenaline, 1:1000, 0.5ml sc. Repeat after 1/2 if patient
doesn’t respond.
 Systemic steroids
• Hydrocortisone, 200mg IV as a single dose.
Further IV doses are needed only if oral dosing
is not possible (100mg, IV, 3-4 X per day).
Followed by Prednisolone, 40-60mg P.O.,
should be started immediately, for 5-7 days.
 Followed by

Prednisolone, 40-60mg P.O., should be started

immediately, for 5-7 days.
Discontinuation does not need tapering
 mild asthma

First line
Salbutamol, inhaler 200microgram/puff, 6
puffs to be taken as needed but not more
than 3-4 times a day, or tablet, 2-4mg 3-4
times a day
 Persistent moderate asthma

Salbutamol, inhalation 200/puff 6p�g/puffs as

needed PRN not more than 3-4
times a day.
PLUS (Inhaled corticosteroid)
Beclomethasone, oral inhalation 200�g, BID.
Decrease the dose to 100�g, BID if
symptoms are controlled after three months.
 Severe asthma
•
Salbutamol, inhalation 200/puff 1-2p�g/puffs as needed PRN not
more than 3-4
times a day.
PLUS (Inhaled corticosteroid)
Beclomethasone, oral inhalation 200�g, BID. Decrease the dose to
100�g, BID if
symptoms are controlled after three months.
OR (Preferred if symptoms are mor severe or if response is not
optimal to
Beclomethasone)
• Prednisolone, 5-10mg P.O., QOD. Doses of 20-
40mg daily for seven days may be
needed for short-term exacerbations in
patients not responding to the above
treatment.