seminar asthma.pdf

7/25/2019 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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25/39 Global Initiative for Asthma

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

seminar asthma.pdf

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