overview
Asthma is a chronic inflammatory disorder of airway
Asthma is like an iceberg
Symptoms Recurrent episodes of wheezing
 Troublesome cough at night
 Cough,wheez,chest tightness after exposure to airborne allergens or pollutant
 Cough or wheeze after exercise
 Colds go to the chest or takes more than 10 days to clear
Since these symptoms could occur due to the other causes also, your doctors would have to confirm
the diagnosis
Triggers of Asthma
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Dust mite
Pollens from grass,trees,plants and flowers
Indoor moulds
Smoke
Smell
Viral infection
Exercise
Weather change
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Temperature change
Cockroaches
Infection in upper airway,nose,throat
What happen to lung during asthma attack?
The airway mucosa (inner lining of airway) swells up and secrets thick mucus, which obstructs the
airways. The muscles around the airway tighten making the airway narrower. All this makes
breathing very difficult.
If the doctor suspects asthma how will he confirm the diagnosis?
Detailed evaluation of symptoms
Physical examination
Routine tests for example x-ray chest, blood test etc
Pulmonary function test
what are the medications used for treatment of asthma and how they work
Asthma treatment consist of two basic classes of medications
1. Rescuer or reliever medications
2. Preventer medications
Rescuer medications dilate the tubes of the lungs and are called bronchodilators. They give
immediate relief from symptoms but their effect last only for 4 to 6 hours
Preventer medication control asthma attacks and control asthma better. These medications
reduces inflammation and widens the air tube that help in reduction of the symptoms
So that preventer medications should be taken regularly till the doctor advice it to be stopped.
What are inhalers?
The inhalers are devices by which the medications are delivered into the tubes of the lung. with the
help of inhaler drug can be delivered directly to the larger surface area of the air tubes resulting in
rapid action.
As inhaler devices directly deposit the medicine into the lung tubes, dose of medicine is reduced
significantly.
The same medicines in the form of tablets, injections, syrups have side effects where as inhaler does
not have any side effect.
What should i do keep my asthma under control
Take the correct amount of medicine.
Avoid coming in contact with allergen.
Avoid asthma triggers.
Avoid emotional stressful situations.
Regular follow up with your physician.
Complications of asthma
Complication of asthma includes respiratory failure, death and growth retardation in children
What are the myths and realities of the asthma?
Myths
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Asthma is a contagious disease
People with asthma can not work or exercise
Inhalers are addictive
Inhales are very strong and they should be used as last resort in asthma
Steroid inhalers have a lot of side effects
Realities
Asthma is not a contagious disease
Asthmatics on regular treatment can work and exercise normally
Inhalers are not addictive
Inhalers deliver a small dose of medicines and so that they are the first and safest form of treatment
for asthma
Inhaled steroids are safe even if taken for a prolonged period.
Asthma control test (for people 12 years and older)
Know your score share your result with your doctor
Step 1 write the number of each answer in the score box provided
Step2 add the score boxes for your total
Step 3 take the test to the doctor to talk about your score
1. in the past 4 weeks,how much of the time did your asthma keep you from getting as
much at work,school or at home?
All the time (1)
(4)
Most of the time (2)
A little of the time (3)
None of the time
During the past 4 weeks,how often have you had shortness of breath?
All the time (1)
(4)
Most of the time (2)
A little of the time (3)
None of the time
During the past 4 weeks,how often did your asthma symptom(wheezing,coughing,shortness
of breath,chest tightness or pain) wake up at night or earlier than usual in the morning?
All the time (1)
(4)
Most of the time (2)
A little of the time (3)
None of the time
During the past 4 weeks,how often you used your rescue inhaler or nebulizer medications?
All the time (1)
(4)
Most of the time (2)
A little of the time (3)
None of the time
How would you rate your asthma control during the past 4 weeks?
All the time (1)
(4)
Most of the time (2)
A little of the time (3)
None of the time
Copyright
If your score is 19 or less, your asthma may not be controlled, talk to your doctor
Types of asthma
1. Allergic asthma2. Nonallergic asthmaNon allergic asthma is more likely to occur in subjects <4 years or older than 60 years of age.
Episodes are triggered by ongoing inflammation, by upper respiratory infection, purulent
rhinitis and exacerbation of chronic rhinitis. Most patients have no evidence of IgE
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antibodies. Indoor air pollution from volatile organic compounds, formaldehyde and wood
burning stoves are the trigger factor .
Potentially fatal asthma
Malignant potentially asthma
Aspirin induced asthma
Occupational asthma
Exercise induced asthma
Variant asthma
Factitious asthma
Vocal cord dysfunction and asthma
Coexistent asthma and chronic obstructive pulmonary disease
Irreversible asthma
Asthma in special situation
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Asthma in elderly
Asthma in pregnancy
Asthma in diabetics
Asthma with COPD
Asthma with IHD
Asthma in psychiatric disorder
Unresponsive asthma
Antiasthma therapy is very effective in treating and controlling asthma symptoms but few
patients fail to respond, and continue experiencing troublesome asthma related symptoms even
on taking asthma medications on regular basis.
The reason behind unresponsiveness is commonly due to the wrong inhaler technique, tobacco
smoke, significant environmental allergen exposure and significant occupational exposure.
Beside this some drugs for example beta blockers, NSAIDS, ACE inhibitors produces asthma like
symptoms.
Any concurrent disease for example gastroesophageal reflux disease, COPD, chronic sinusitis,
rhinitis, systemic disease, thyrotoxicosis and vasculitis may be the cause of poor symptom
control.
Your physician needs to diagnose and treat the concurrent medical condition for the better
control.
Complicated asthma
Although most asthma patients respond well to comprehensive treatment, a few with symptoms and signs of
severe asthma supported by objective evidence of obstructive airway disease will have a decidedly inadequate
response to treatment Less than 5% of asthma patients are diagnosed with severe asthma. Among these, some
fail to respond to even aggressive asthma management. Such patients are often treated with daily oral
corticosteroids, and many become steroid dependent. However, some severe asthma patients have a poor
response to even high doses of glucocorticosteroids. Many become steroid-dependent. The term steroidresistant asthma has been applied to asthma patients who have little or no objective response (improvement in
FEVâ‚•) to even prolonged treatment of high-dose glucocorticosteroids.
It is now clear that the category of severe unresponsive asthma is heterogenous and includes not only steroidresistant asthma, but also other severe asthmatics that are affected by various comorbidities (e.g., GERD,
chronic sinusitis, paradoxical vocal cord dysfunction, bronchopulmonary aspergillosus, psychopathology,
uncontrolled triggers {allergens and pollution} immunodeficiency, etc.). These patients may benefit from a
consultation at a major academic center (e.g., National Jewish Health) for a second opinion, always searching
for a solution.
Brittle asthma is a rare form of severe asthma characterized by a wide varia- tion of Peak Expiratory
Flow (PEF), in spite of heavy doses of steroides.
Brittle asthma is classified in two types: type 1 characterized by a maintained wide PEF
variability (> 40% diurnal variation for > 50% of the time over a period of at least 150 days)
despite maximal medical therapy.
Type 2 is characterized by acute attacks oc- curing within minutes, that coul lead to death,
with a background of well controlled asthma.
Sex F/M
Age yr
Atopy
Food intolerance
Psychological factors
Morbidity
Mortality –
Type 1
Type 2
2.5 F: 1 M
15-55
Yes
Yes
Yes
High –
1F:1M
*–
No
No
No
High
Treatment of asthma
Avoidance therapyYou are advised to avoid the allergens diagnosed by allergy testing by your physician
Pharmacotherapy
Medicines are prescribed for symptomatic relief.
Immunotherapy