seminar asthma.pdf
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Airway inflammation
Bronchial
hyperresponsiveness
Intermittent airflow
obstruction
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Intermittent symptomatic episodes of:
Coughing (day, night, or with exercise)
Difficulty breathing/Shortness of breath
Wheezing (a whistling noise)
Chest tightness
Trouble sleeping/ waking at night
May be asymptomatic between attacks
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Inspection:- shape: hyperinflated insevere asthma
- movement of chest/silentchest (life-threatening)
- chest deformity:
- recession:
Palpation:
- chest expension may be
reduce (hyperinflated)/normal
- apex beat: may bedisplaced
-vocal fremitus: decrease
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24/39 Global Initiative for Asthma
GINA assessment of symptom control
A. Symptom control
In the past 4 weeks, has the patient had:Well-
controlledPartly
controlledUncontrolled
Daytime asthma symptoms morethan twice a week?
Yes No
None ofthese
1-2 ofthese
3-4 ofthese
Any night waking due to asthma?
Yes No
Reliever needed for symptoms*more than twice a week?
Yes No
Any activity limitation due to asthma?
Yes No
B. Risk factors for poor asthma outcomes
Assess risk factors at diagnosis and periodically Measure FEV at start of treatment, after 3 to 6 months of treatment to record the atients!"#$ &'() *+, &-&* (/0
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Assessment of risk factors for poor asthma
outcomes
GINA 2015 Box 2-2B 4/4
Risk factors for exacerbations include: Ever intubated for asthma
Uncontrolled asthma symptoms
Having !1 exacerbation in last 12 months
Low FEV1(measure lung function at start of treatment, at 3-6 monthsto assess personal best, and periodically thereafter)
Incorrect inhaler technique and/or poor adherence
Smoking
Obesity, pregnancy, blood eosinophilia
Risk factors for fixed airflow limitation include:
No ICS treatment, smoking, occupational exposure, mucushypersecretion, blood eosinophilia
Risk factors for medication side-effects include:
Frequent oral steroids, high dose/potent ICS, P450 inhibitors
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Global Initiative for Asthma
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Global Initiative for Asthma
" How often should asthma be reviewed?
#
1-3 months after treatment started, then every 3-12 months
# During pregnancy, every 4-6 weeks
# After an exacerbation, within 1 week
" Stepping up asthma treatment
#
Sustained step-up, for at least 2-3 months if asthma poorlycontrolled
# Short-term step-up, for 1-2 weeks, e.g. with viral infection or
allergen
# Day-to-day adjustment
"
Stepping down asthma treatment
# Consider step-down after good control maintained for 3 months
# Find each patients minimum effective dose, that controls both
symptoms and exacerbations
Reviewing response and adjusting treatment
GINA 2015
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" Avoidance of tobacco smoke exposure
" Encourage physical activity
" Occupational asthma
# Ask patients with adult-onset asthma about work history. Remove
sensitizers as soon as possible.
"
Avoid medications that may worsen asthma
# Always ask about asthma before prescribing NSAIDs or beta-
blockers
Non-pharmacological interventions
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