BRONCHIAL

ASTHMA AND
ACUTE ASTHMA
 HETEROGENOUS DISEASE

DEFINITION CHARACTERIZED BY CHRONIC AIRWAY

INFLAMATION

DEFINED BU HISTORY OF REPIRATORY

SYMPTOMS SUCH AS WHEEZE, SHORTNESS OF
BREATH, CHEST TIGHTNESS AND COUGH THAT
VARY OVER TIME AND INTENSITY TOGETHER
WITH VARIABLE AIRFLOW LIMITATION
Reversible and variable airflow limitaton as evidenced by
>15% improvement in PEFR (Peak Expiratory Flow Rate), in
response to administraton of a bronchodilator
EPIDEMIOLOGY
•The Internatonal Studies on Asthma And Allergy (ISAAC) has shown
that the prevalence of asthma among school age children is 10%
•According to National Health and Morbidity Survey 2011, the
prevalence of asthma in Malaysia is at 6.3%. 
CLINICAL PNENOTYPES
•ALLERGIC ASTHMA
•NON ALLERGIC ASTHMA
•ADULT ONSET
•ASTHMA WITH PERSISTANT AIRFLOW LIMITATION
•ASTHMA WITH OBESITY
 • recurrent or persistent non-productve cough that worsens atnight or
accompanied by wheezing or breathlessness. occurring in the absence of
COUGH respiratory infectons, usually with laughing, crying or exposure to tobacco smoke.

• Recurrent wheezing during sleep or with triggers such as

actvity, laughing, crying or exposure to tobacco smoke or air polluton
Wheezing

• not running, playing, or laughing at the same intensity

Reduced
actvity: as other children

• Past or family history of allergic disease or history of asthma in frst

Family degree relatve.
history
Management
Drug therapy
AGE ORAL MDI+ MDI + MASK DRY PER
SPACER + SPACER INHALER
<5 + + - -
5- 8 - + - -
>8 - + + +
Monitoring
3 issues
1. assessment of asthama control
2. compliance to asthma therapy
3. asthma education
Management on acute exacerbation of
asthma
1. Initial assessment+ short history:
◦ trigger factors
◦ diagnosis
◦ severity: monitir pulse, colour, PEER, ABG and SPO2 (close monitor for at least
4 hours)
2. hydration- fluid maintenance
3.role of aminophylline
4.IV Mg SO4
Case Scenario
X, 5 years old boy was brought by his mother to clinic. he was known case of bronchial asthma
which diagnosed 2 years ago.
He presented with rapid breathing for 2/7, cough for 1/52 and wheeze for x 1/7. His mother
noticed that his son worsening cough for this month. He has morning cough / nigh cough almost
2 times a week. he also visit nearest GP last month due to shortness of breath. further history,
he was admitted to Hospital last year for AEBA secondary to bronchopneumonia. he usually
require nebulisation 2- 3 monthly. trigerring factors : URTI and dust. otherwise, he can play well
with neighbour kids, running around. occasionally he will have catching breath episode. but
mother claimed resolved after rest.
Family history suggestive of brochial asthma- father had childhood asthma and his mother has
allergic rhinitis. father is a cigrate smoker. there was a golden retriever in his house.
Currently , he is on MDI Salbutamol 2pff PRN & MDI budesonide 200mg BD
what will you do ?
The boys is talking to you comfortably, pink, sit in decubitus.
Pulse. 108
BP :95/75 T. 37
RR: 40 SPO2: 96% under room air +mild SCR
Throat: injected. tonsil not enlarged
presence of ezema over flexor area of bilateral nads and legs
harrison sulcus, hyperinflated chest
Lungs: air entry equal, prolonged expiratory phase, +rhonchi, no crepitation
CVS DRNM
PA soft, liver palpable ( 2 finger breath)
Diagnosis
Mild AEBA secondary to URTI with
underlying mild persistent
bronchial asthma
management:
1. put on Nasal Prong O2
2. Blood invastigation: FBC
3. CXR
4. neb subutamol 200mg STAT & reassessment
long term plan:
1. icrease dose of MDI budesonide to 400mcg BD
2. avoild triggering factor
3. asthma action plan
4. follow up
• reveiw patient month after initiation of preventrr or readjusting the dose of
preventer. if remain stable after 3 months of treatment , it can be stepped down.