Bronchial Asthma

Eghan BA
Dept. of Medicine
 Plan of the lecture
1. Definition of bronchial asthma
2. Etiology
3. Pathogenesis
4. Diagnostic criteria
5. Classification
6. Principles of treatment
7. Steps of treatment
Methods of investigation
• Objectively: Tachypnoe with prolonged
expiration, wheezing, dry crackles
• Sputum analysis:
• eosinophils
• Kurshman spirals (mucus from small bronchi),
• Sharko-Leiden crystals (enzymes of eosinophils)
• General blood analysis: mild leucocytosis,
eosinophilia
• Spyrometry: decreased FVC, FEV1, FEV1/FVC,
increased daily variability
!CHILDREN!
!ONLY IN THIS STAGE!
-If it necessary – hospitalization with i/v infusion of
glucocorticosteroids and euphyllin
Severe asthma
 Severe asthma
• Severe attack:
• Unable to complete sentences
• Respiratory rate >25/​min
• Pulse rate >110 beats/​min
• Peak expiratory flow <50% of predicted or
best
 Life-threatening attack:

• Peak expiratory flow <33% of predicted or best

• Silent chest, cyanosis, feeble respiratory effort
• Bradycardia or hypotension
• Exhaustion, confusion, or coma
• Arterial blood gases:
• normal/​high P aCO2 >4.6kPa (32mmHg)
• P aO2 <8kPa (60mmHg), or SaO2<92%
• low pH, eg <7.35
• Sit patient up and give high-dose O2 in 100%
• Salbutamol 5mg (or terbutaline 10mg) plus
ipratropium bromide 0.5mg nebulized with O2.
• Hydrocortisone 100mg IV or prednisolone 40-
50mg PO or both if very ill.
• Rule out pneumothorax (Chest Xray).
• Add magnesium sulphate (MgSO4) 1.2–2g IV
over 20min.
• If not improving
• Give salbutamol nebulizers every 15min,
or 10mg continuously per hour.
• Monitor ECG; watch for arrhythmias.
• Monitor peak flow and oxygen saturations.
• If patient not improving after 15–30min
• Continue 100% O2 and steroids.
• Consider aminophylline; if not already on a
theophylline, load with eg 5mg/​kg IVI over
20min, then 500μg/​kg/​h
•  IPPV may be required.
• consider transfer to ITU, accompanied by
a doctor prepared to intubate.