global initiative for asthma guidelines 2008

Download Global Initiative For Asthma Guidelines 2008

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The comparison between old and new GINA Guidelines.

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  • Global Initiative for Asthma Management 2009: Please visit: http://crisbertcualteros.page.tl
  • GLOBAL INITIATIVES FOR ASTHMA (GINA)
    • Initiated in 1989
    • US National Heart, Lung and Blood Institute
    • National Institute of Health
    • World Health Organization
    • OBJECTIVES:
    • To increase appreciation for global public health
    • perspectives of asthma
    • Recommend diagnostic and management strategies
    • Identify areas for future investigations
  • Objectives:
    • To present and compare the GINA 2002 with GINA
    • 2006-07 guidelines
    • To update clinicians with the newer approach to the management in children
  • GINA ASTHMA GUIDELINES:
          • 2002 2006-07
    EMPHASIS: CLASSIFICATION ASTHMA MANAGEMENT OF PATIENT BY BASED ON CLINICAL SEVERITY CONTROL DEFINITION: IMPACT OF THE CLINICAL,PHYSIOLOGICAL DISEASE ON LUNG AND PATHOLOGICAL FUNCTION CHARACTERISTICS - airflow limitation - episodic shortness of - its reversibility breathing - airway hyper- - wheezing responsiveness - cough
  • GINA ASTHMA GUIDELINES:
          • 2002 2006-07
    PATHOLOGY: Acute and Chronic Inflammation Inflammation is persistent Inflammation affects all airways more in the medium sized bronchi
  • GINA ASTHMA GUIDELINES:
          • 2002 2006 -07
    Pathophysiology: Airway Narrowing : - Airway smooth muscle contraction - Airway edema - Airway thickening - Mucus hypersecretion Airway Hyperresponsiveness
  • GINA ASTHMA GUIDELINES :
          • 2002 2006 - 07
    • Asthma is a chronic inflammatory disorder of the airways
    • is associated with airway hyperresponsiveness
    • recurrent episodes of wheezing
    • Breathlessness
    • chest tightness
    • coughing
  • GINA ASTHMA GUIDELINES:
          • 2002 2006-07
    Factors Influencing the Development and Expression of Asthma HOST FACTORS Genetic, e.g., Genes pre-disposing to atopy Genes pre-disposing to airway hyperresponsiveness Obesity Sex ENVIRONMENTAL FACTORS Allergens Indoor: Domestic mites, furred animals(dogs, cats, mice) cockroach allergen, fungi, molds, yeast Outdoor: Pollens, fungi, molds, yeasts Infections (predominantly viral) Occupational sensitizers Tobacco smoke Passive smoking Active smoking Outdoor/Indoor Air Pollution Diet
  • GINA ASTHMA GUIDELINES 2002, 2006, 2007 DIAGNOSIS: Reversibility of measurements of lung function enhances confidence in making a diagnosis of asthma Often prompted by symptoms: episodic breathlessness wheezing cough chest tightness Assessment of the severity of airflow limitation Reversibility and variability confirms the Diagnosis of asthma Asthma severity: Amount of daily medications required for optimal treatment Asthma severity is measured NOT by severity of the underlying disease BUT its responsiveness to treatment 2002 2006 - 07 Measurement of allergic state helps to identify Risk factors that causes asthma symptoms in patients
  • GINA ASTHMA GUIDELINES:
          • 2002 2006-07
    Clinical Control of asthma is defined as:
    • No (twice or less/week) daytime symptoms
    • No limitations of daily activities, including
    • exercise
    • No nocturnal symptoms or awakening because
    • of asthma
    • No (twice or less/week) need for reliever
    • treatment
    • Normal or near normal lung function
    • No exacerbations
  • EMPHASIS: CLASSIFICATION ASTHMA MANAGEMENT OF PATIENT BY BASED ON CLINICAL SEVERITY CONTROL
          • 2002 2006 - 07
    GINA ASTHMA GUIDELINES:
  • WHAT DETERMINES DISEASE CLASSIFICATION IN GINA 2002 ?
    • Worst feature determines the severity classification
    • Useful when decisions are being made about management at the initial assessment of a patient
  • ASTHMA SEVERITY (GINA 2002)
    • Involves both the severity of the underlying disease and its responsiveness to treatment.
    • May change over months or years
  • VALUE OF GINA 2002 GUIDELINES
    • Cross sectional means of characterizing patients with asthma who are not on inhaled corticosteroids treatment
      • No maintenance
      • Newly diagnosed
      • No previous consult
    • No longer recommended as basis for ongoing treatment
  • ASTHMA CONTROL (GINA 2006)
    • Refers to control of the clinical symptoms of the disease
    • Treatment is aimed at controlling the clinical features of disease
  • GINA ASTHMA GUIDELINES: Questions to consider in the Diagnosis of Asthma
    • Has the patient had an attack or recurrent attacks of wheezing?
    • Does the patient have a troublesome cough at night?
    • Does the patient wheeze or cough after exercise?
    • Does the patient experience wheezing, chest tightness or cough
    • after exposure to airborne allergens or pollutants?
    • Do the patients colds go to the chest or take more than 10 days
    • to clear up?
    • Are symptoms improved by appropriate asthma treatment?
  • GINA ASTHMA GUIDELINES: Diagnosis and Classification 2002 Classification of Asthma Severity by Clinical Features Before Treatment Intermittent: Mild Moderate Severe Persistent: Persistent: Persistent: Symptoms less than once a week Brief exacerbations Nocturnal symptoms NOT more than twice a month FEV 1 or PEF80% Predicted PEF or FEV 1 variability 20-30% Symptoms more Than once a week But less than once A day Exacerbations may Affect activity and Sleep Nocturnal symptoms More than twice a Month FEV 1 or PEF 80% Predicted PEF or FEV 1 variability 20-30% Symptoms daily Exacerbations may Affect activity and sleep Nocturnal symptoms more than once a week Daily use of inhaled short acting 2 -agonist FEV 1 or PEF 60-80% Predicted PEF or FEV 1 variability>30% Symptoms daily Frequent exacerbations Frequent Nocturnal asthma symptoms Limitation of physical activities FEV 1 or PEF 60% Predicted PEF or FEV 1 Variability > 30%
  • Classify Asthma Based on Severity: Severity INTERMITTENT PERSISTENT Mild Moderate Severe Daytime Symptoms < 1x a week 1x/wk Daily Daily Affects daily Limits daily activities activities Nighttime Symptoms 2x/month >2x/month >1x/week Frequent PEF 80% 80% >60-30% variability variability variability variability FEV1 80% 80% 60-79% 2 months < 60/min 2-12 months < 50/min 1-5 years < 40/min 6-8 years < 30/min GINA 2002, 2006, 2007
  • MILD MODERATE SEVERE RESPIRATORY ARREST IMMINENT Accessory None Present Present Present Muscles & Thoraco-abdominal Suprasternal Movement Retraction Wheeze Audible with Audible with Audible w/o Absence of wheeze stethoscope stethoscope stethoscope with decreased to absent breathe sounds Pulses/min 120 Bradycardia GUIDE TO LIMITS OF NORMAL PULSE RATE IN CHILDREN Age Normal Limits Infants 2-12 months 400 Dipropionate Budesonide 100-200 >200- 400 >400 Ciclesonide 80-160 >160-320 >320 Flunisolide 500-750 > 750-1250 > 1250 Fluticasone 100-200 > 200 500 >500 Mometasone 100-200 >200 500 >400 furoate Triamcinolone 400-800 >800 1200 > 1200 acetonide GINA ASTHMA GUIDELINES 2002,2006-07
  • Choosing an Inhaler Device for Children with Asthma Age Group Preferred device Alternate Device Younger than 4 years Pressurized metered Nebulizer with face dose inhaler plus mask dedicated spacer with face mask 4 6 years Pressurized metered Nebulizer with dose inhaler plus mouth piece dedicated spacer with mouth piece Older than 6 years Dry powder inhaler, Nebulizer with mouth or breath-actuated piece pressurized metered- dose inhaler or pressurized metered dose inhaler with spacer mouth piece
  • Leukotriene Pathway
    • ADD-ON Tre

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