Bronchial asthma

is a chronic
inflammatory disorder of
the airways that
characterized by an
obstruction of airflow,
which may be
completely or partially
reversed.
Airway inflammation

limits airflow and leads to

functionai and structural

changes in the airways in the

form of: bronchospasm,

mucosa! edema, and mucus

production.
 Etiology

, Genetic factors: atopy and airway

hyperreactivity or bronchial hyperresponsiveness
(BHR).
, Allergens can be household inhalants (eg, animal
allergens~ molds, fungi, dust mitest or seasonal
outdoor allergens (mold spores, pollens, grass,
trees), or food.
, Non-specific factors (Respiratory infections -
most commonly viral infections and air
pollutants).
 Some risk factors for persistent
asthma:
• perennial allergies (atopic dermatitis, allergic
rhinitis, food allergy);
• severe lower respiratory tract infections;
• wheezing with exercise, emotions;
• environmental tobacco smoke exposure;
• parental asthma.
 Clinical manifestation of BA

✓ Wheezing . It usually occurs during exha lation.

✓ Cou,gh, especially at night. Usua lly, the cough

is nonproductive and nonpa roxysmal.

✓ Shortness of breath.

✓ Chest tightness.
 Triggers of asthma attack
• changes in atmospheric temperature,
barometric pressure, and humidity,
• allergen content in the air,
• irritants (eg, smoke exposure, chemicals,
vapors)
• emotional factors
•
• exercise
• viral infections
 Physical examination
in an acute episode
✓ tachypnea and dyspnea
✓ anteroposterior diameter of
the chest may be increased
✓ subcostal, intercostal, or
supraclavicular retractions 1n
severe episode
✓ in auscultation: loud
expitatory wheezing and
prolonged exhalation phase
✓ deacreased breath sound can
be in some lung field
 Differential diagnosis

• Cystic Fibrosis • Gastroesophageal

Reflux disease
• Aspiration syndrome
• Pneumonia
• Bronchiolitis
• Allergic rhinitis
• Bronchopulmonary
dysplasia • Croup

• Primary ciliary • Congenital heart

dyskinesil a disease
• Vocal cord
dysfunction
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 Diagnosis
, Gold standard is spirometry during
forced expiration: FEVl (the forced
expiratory volume in 1 second) in
children age ~ 5 yrs.
, Bronchodilator response to inhaled
beta-agonist-improvement in FEVl to
>12% confirms the reversibility of
bronchial obstruction.
, Exercise challenge-worsening in FEVl
of at least 15%.
Peak Flow M eter
Home tool-peak expiratory
home monitoring (PEF}; day-to-
day or a.m. and p.m.
Variation is more than 20 %
from the patient's personal best
supports the diagnosis of BA.
Result based on personal best,
divide PEFs into zones: green
(80--100%), yellow (50--80%),
red (<50%).
Exhaled nitric oxide (FeNO)

• During inflammation

, activated epithelial oells

demonstrate increased
production of NO.

• Children < 5 years can

perform this test.
Chest x-ray
 -
Classification of Asthma S11v• ity
Components of (5 11 r-n of age)
Severity

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 Asthma management

The goal of asthma therapy in children is to

achieve asthma control by
✓ optimizing Iung function,
✓ reducing day and night time symptoms,
✓ reducing limitations in daytime activities
✓ and the need for reliever treatment,
✓ and by reducing asthma exacerbations.
 Asthma management

The goal of asthma therapy in children is to

achieve asthma control by
✓ optimizing lung function,
✓ reducing day and night time symptoms,
✓ reducing limitations in daytime activities
✓ and the need for reliever treatment,
✓ and by reducing asthma exacerbations.
 Asthma management
Medical care includes treatment of
, acute asthmatic episodes
, and control of chronic symptoms (anti-
inflammatory therapy), including nocturnal
and exercise-induced asthmatic symptoms.
The intensity of treatment depends on the
severity of asthma.
Principle "step-up" if necessary and "step-
down" when possible is using.
 Control of chronic symptoms:
• inhaled corticosteroids (are a component of the
preferred treatment regimen for persistent
asthma)
• long-acting bronchodilators (beta 2-agonists and
antic holine rgics),
• theophylline,
• leukotriene modifiers
• and more recent strategies such as the use of
anti-immunoglobulin E (~gE) antibodies
(omalizumab), anti-lLS antibodies, and anti-
ll4/IL13 antibodies in selected patients.
 Treatment of acute exacerbation in
primary care :
1) inhaled short acting beta 2 agonists (SABA) -
every 20 minutes for the first hour with two
possible methods: metered-dose inhaler (MDI)
in conjunction with a spacer OR nebulizer.
2) oxygen therapy - to the SaO 2 > 95% (94-98%)
3) systemic corticosteroids {oral administration
is equivalent in efficiency to intravenous
administration):
Prednisoilone 1-2 mg/kg/day up to a
maximum 20 mg/day for 0-2 years,
30 mg/day for 3-5 years,
40 mg/day for 5-11 years.