BRONCHIAL ASTHMA

PRESENTER: PASCHAL J. JOSEPH

SUPERVISOR: DR HAPPINESS MALYAS

 OUTLINE
Introduction
Etiology and Risk factors
Pathophysiology
Clinical presentation
Investigations
Management
Prevention
Acute exacerbation of asthma
References
 INTRODUCTION
• Pulmonary disease characterized by reversible airway obstruction,
airway inflammation, and increased airway responsiveness to a variety
of stimuli.
• These symptoms respond to treatment with bronchodilators and anti-
inflammatory drugs.
• Bronchial reactivity is a necessary component of asthma
 INTRODUCTION CONT

• Prevalence of asthma among the children in Tanzania found to be

6.4% and 17.6% in Bagamoyo and Ilala districts.
• Higher in males before puberty and in females after puberty.

• Up to 80% of children with asthma develops symptoms before their

5th birthday
Aetiology/risk factors and triggers for
asthma
• Two group of factor
• Environmental triggers
• Host factors
PATHOPHYSIOLOGY
 PATHOPHYSIOLOGY
Airway obstruction in asthma is caused by:

1. Edema and inflammation of mucous membrane lining the

airways
2. Excessive secretion of mucus, inflammatory cells and cellular
debris
3. Spasm of the smooth muscle of bronchi.

Obstruction is diffuse but not uniform

 CLINICAL MANIFESTATION
• Recurrent cough (night/ early morning)
• Recurrent wheeze
• Dyspnea
Others:
• Chest pain
• Sweating profusely, may develop cyanosis and becomes apprehensive
and restless and may appear fatigued
• Excessive use of accessory muscles of respiration.
• Retractions with flaring of nostrils
 CLINICAL PRESENTATIONS….
Severe episodes:
• Air hunger
• Hyper resonant chest because of air trapping
• Severe hypoxemia, cyanosis
• Silent chest – ominous sign
• Pulsus paradoxus – severe illness
• Cardiac arrythmias
 INVESTIGATIONS
• Diagnosis of the disease can be attained by taking proper history, doing
physical examination and other investigations.
The investigations include:-
a)Chest x ray
b) Spirometry
• Spirometry is a quick, painless test using a tool called a spirometer to
measure how much air a person's lungs can hold. It also tests the speed of
inhalations (breathing in) and exhalations (breathing out). This test
is given to children older than 5 years
• Help to establish the diagnosis and also monitor response to treatment
• Used to measure severity of asthma exacerbations
 INVESTIGATIONS
Others;
Allergy skin testing
• Should be included in the evaluation of all children with
persistent asthma
• Should not be undertaken during exacerbation of wheezing
 Diagnosis
1.Hx of variable respiratory symptoms(wheeze, SOB,chest tightness,
cough)
I. More than 1 symptoms
II. Vary in time and intensity
III. worse at night or on waking up
IV. triggered by exercises, allergens, cold air etc
2. Evidence of variable expiratory airflow limitation
FEV1 is low
FEV1/FVC is below the limit of normal (0.8)
variation in expiratory lung function
 MANAGEMENT

Key components in the treatment of asthma includes;

1. Assessment and monitoring of disease activity

2. Education to enhance the patient's and family's knowledge and

skills for self-management

3. Identification and management of precipitating factors and co-

morbid conditions that may worsen asthma and

4. Appropriate selection of medications to address the patient's needs.

• Quick relief medications
Short acting B2 agonists e.g.. salbutamol
Anticholinergic agents e.g.. Ipratropium bromide
Oral corticosteroids e.g.. prednisone
 LONGTERM MANAGEMENT

• Long term control medications

Inhaled corticosteroids eg budesonide, fluticasone,
beclamethasone etc
Leukotriene modifiers eg. Zafirlukast, montelukastt
Long acting B2 agonists eg. Salmeterol,formeterol
Theophylline
Omalizumab – humanized anti-IgE monoclonal antibody
that prevents binding of IgE to receptors on basophils and
mast cells
 DEVICES
• Selection of appropriate inhalation device;
1. MDI with a spacer and face mask(< 4 years)
2. MDI with a spacer(> 4 years)
3. Metered dose inhaler( MDI) (> 12 years)
4. Rotahaler( dry powdered inhaler)
5. nebulizer
 FOLLOW UP AND PREVENTION
• Follow up:
Clinic visits every 2 to 4 weeks until good control is
achieved, 2-4 per year to maintain good control
Frequency of symptoms, lung function monitoring
School absenteeism, sleep disturbances, physical activity,
need for rescue bronchodilators and PEFR recorded in a
symptom diary
Side effects of drugs, record weight & height, PFTs
• Prevention:
Patient and child education!!
Allergen avoidance – no smoking, clean carpets, curtains
Avoidance of exertional activities
Home management of mild acute exacerbations and when to
immediately bring the child to the health center
 Acute exacerbation of asthma
• Severe asthma that does not respond to quick reliefers within 24
hours.
• It present as severe acute asthma
presents with:-
 drowsiness
Bradycardia
Absent pulsus paradoxus
Paradoxical thoraco-abdominal movement
Absent wheezes
 Acute exacerbation of asthma cont…
• MANAGEMENT OF STATUS ASTHMATICUS
Admit to ICU, monitor vital signs and ABGs
Chest X-rays (to exclude complications like pneumothorax, lung
collapse)
Supportive : humidified oxygen, IV fluids, IV antibiotics (secondary
infections; fast breathing, chest wall indrawing)
Specific : bronchodilators(SABA and ipratropium bromide inhalation
every 20min for 3 doses then hourly and continuous cardiac monitoring)
I.V prednisolone 1mg/kg/6hr for 48 hours
 Acute exacerbation of asthma cont..
• Other bronchodilators which can be used
Theophyllline I.V infusion 0.5-1mg/kg/hr
Subcutaneous epinephrine
• In case of respiratory failure; Mechanical ventilation
 REFERENCES
• Nelson textbook of pediatrics 21th Edition
• CURRENT Diagnosis & Treatment in Pediatrics 19 th Edition
• Baby Nelson Pediatrics
• Ghai pediatric textbook 8th Edition
• Slide share
• Global Initiative For Asthma (GINA) updated 2021