A clinical evidence and

management of asthma

Submitted To-

Submitted by-

Mr. Ankur Garg

Sachin

Introduction

The word asthma is of Greek origin and means panting

Hippocrates used the word asthma to describe episodic
shortness of breath.
Asthma is an inflammatory disease of the airways in which the
mucous membrane and muscle layers of bronchi become
thickened and the mucous glands enlarge, reducing airflow in
the lower respiratory tract
It causes recurring periods of wheezing (A whistling sound
when we breath), chest tightness, shortness of breath and
coughing.
The coughing often occurs at night or early in the morning.

Types of asthma
Asthma

Extrinsic
asthma

Intrinsic
asthma

Mixed
type

Extrinsic asthma- It is most common in childhood

and caused by exposure to definite allergens.
It occurs in children and young adults who have
atopic(Type-1) hypersensitivity to foreign proteins.
Intrinsic asthma- It usually develops beyond age of
40 and have many causes other than exposure to
allergens.
In this case there is no history of childhood allergic
reactions.
Mixed types Many patients do not clearly fit in to
either of the above two categories and have mixed
features of both.

Symptoms
Wheezing (whistling sound when we breath)
Painless tightening in the chest
Shortness of breath
Difficulty exhaling
Dry persistent cough
Sweating
Coughing

Factors that may precipitate Asthma attack Cold air

Cigarette smoking
Air pollution
Upper respiratory tract infection
Emotional stress
Strenuous exercise

DIFFERENCE BETWEEN NORMAL AND ASTHMATIC

PERSON
Airways narrow, caused
by:
tightening of the
muscles that
surround the
airways
swelling of the
inner lining,
and/or
increase in mucus
production
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REASON OF ASTHMA

Pathophysiology
Exposure of stimuli/allergens
Production of Ige
antibody
Release of vasoconstrictor
& inflammatory substances
by mast cell
Inflammation & vasoconstriction

Enhanced mucus secretion

Airway narrowing and abstruction
12/07/14

Precipitation of

PHARMACOLOGY

Diagnosis
Lung function test(a) Spirometry - It is an instrument which
measures how quickly the lungs fill and empty.
(b)Lung volume test-It shows how much air the
lungs can hold.
Measuring blood gasesMeasuring the levels of oxygen (o2) and carbon di
oxide (co2) in the blood helps in the diagnosis and
monitoring of lungs disorders.

Treatment and Management

The National Asthma education programme(NAEP)
has provided the following goals for asthma
management Maintain normal activity levels(including
exercise).
Maintain normal pulmonary function rates.
Prevent chronic and troublesome symptoms (egcoughing or breathlesness in the night or early
morning).
Prevent recurrent exacerbations of asthma.
Avoid adverse effects from asthma medications.

Treatment of asthma

Nonpharmacological
treatment

Pharmacological
treatment

Non-pharmacological
treatment
Avoid smoking.
In emergency oxygen therapy should be given.
Hemoglobin desaturation produced by Va/Q
mismatching.
Patient should be hospitalized with acute severe
asthma.
Excessive hydration should be avoided to prevent
excessive lung fluid at a time, when patient have
inflammation and bronchial edema.

Pharmacological treatment
Bronchodilators(a)Beta-sympathomimeticsSalbutamol
Terbutaline
Bambuterol
(b)Methyl xanthinesTheophylline
Aminophylline
Choline theophyllinate
(c)AnticholinergicsIpratropium bromide
Tiotropium bromide

Leukotriene antagonistsMontelukast
Zafirlukast
Mast cell stabilizersSodium cromoglycate
Ketotifen
Corticosteroids(a) SystemicHydrocortisone
Prednisolone
(b) InhalationalBeclomethasone dipropionate
Budesonide
Fluticasone propionate

Anti-IgE antibodyOmalizumab

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