ASTHMA: USE

OF MDI AND
PEFR
SEOKA HT
MBChB VI
2023
FAMILY MEDICINE
OUTLINE:
• INTRODUCTION
• DEFINATION
• CAUSES
• CLINICAL MANIFESTATIONS
• PATHOPHYSIOLOGY
• INVESTIGATIONS
• MANAGEMENT
• HOW TO USE A PEAK EXPERATORY FLOW METER
• HOW TO USE MDI
 ASTHMA IS THE MOST CHRONIC
ILLNESS IN SOUTH AFRICAN CHILDREN
AND ITS PREVALENCE IS INCREASING IN
BOTH URBAN AND RURAL AREAS.

INTRODUCTI
ON SOUTH AFRICA IS RANKED 25TH
WORLDWIDE FOR ASTHMA
PREVALENCE AND 5TH FOR ASTHMA
MORTALITY, WITH AN ESTIMATED 18.5
DEATH PER 100,000 ASTHMA CASES
 • IS AN OBSTRUCTIVE LUNG DISEASE
CHARACTERIZED BY CHRONIC AIRWAY
INFLAMMATION AND HYPER-RESPONSIVENESS
LEADING TO
-WHEEZE
-COUGH
-CHEST TIGHTNESS
DEFINATION: - DYSPNOEA
• A TRIAD OF HYPER-RESPONSIVENESS, MUCOSAL
OEDEMA AND MUCUS PRODUCTION
• AIRFLOW IN ASTHMA IS VARIABLE OVER TIME AND
REVESIBLE WITH TREATMENT
• RELATIONSHIP BETWEEN ATOPY AND ASTHMA IS
ESTABLISHED
 • COMMON ALLERGENS INCLUDES:
-house dust mites
-cat, dogs, and cockroaches
-fungi
• ALLERGY IS IMPLICATED IN SOME CASES OF OCCUPATIONAL ASTHMA
• DRUGS:
-ASPRIN USE CAUSES ASTHMA THROUGH PRODUCTION OF CYSTEINYL
LEUKOTIENES, USUALLY THIS PATIENTS HAVE A ASTHMA,
CAUSES: SINUSITIS+RECCURENT POLYPS AND SENSITIVITY TO ASPRIN ( GARMET
TRIAD)
-BETA-BLOCKERS
• EXERCISE INDUCED ASTHMA,HYPER-VENTILATION RESULTING IN
WATER AND HEAT LOSS FROM AIRWAY LINING AND THOSE FLUIDS
TRIGGER THE RELEASE OF MEDIATORS

• VIRAL RESPIRATORY INFECTIONS

• COLD WEATHER
 IN PERSISTENT ASTHMA, THERE IS A
CHRONIC INFLUX OF INFLAMMATORY
CELLS INTERACTING WITH AIRWAY
STRUCTURAL CELLS, AND THE SECRETION
OF CYTOKINES, CHEMOKINES AND
GROWTH FACTORS
PATHOPHYSIO
LOGY: WITH INCREASED SEVERITY AND
CHRONICITY OF ASTHMA, AIRWAY
REMODELLING MAY OCCUR WITH
FIBROSIS AND FIXED NARROWING OF THE
AIRWAYS AND REDUCED RESPONSE TO
THE USE OF BRONCODILATORS
CLINICAL MANIFESTATIONS:
• RECURRENT EPISODES OF WHEEZING
• CHEST TIGHTNESS
• COUGH
• IN MILD INTERMITTENT ASTHMA PATIENTS MAY BE ASYMPTOMATIC IN BETWEEN
ATTACKS
• IN PERSISTENT ASTHMA, PATIENTS MAY HAVE CHRONIC WHEEZE AND
BREATHLESSNESS
• THERE IS DIURNAL VARIATION IN SYMPTOMS
-WHEEZE EARLY IN THE MORNING
-SLEEP OFTEN DISTURBED BY COUGH AND WHEEZE
 INVESTIGATIONS:
MEASUREMENT OF ALLERGIC
PULMONARY FUNTION TEST CHEST X-RAY
STATUS
• INCREASE IN FEV1 OF MORE • USUALLY NORMAL • TOTAL IgE ALLERGEN TEST
THAN 15% FOLLOWING USE • LOBAR COLLAPSE IF MUCUS OR SKIN PRICK TEST OR
OF BRONCHODILATORS HAS OCCLUDED LARGE PHADIOTOPE TEST OR FX-5
• MORE THAN 20% DIURNAL BRONCHUS
VARIATION ON MORE THAN • HYPER-VENTILATION IN
3 DAYS IN A WEEK ON PEF- ACUTE ASTHMA
METER DAILY • FITTING INFILTRATES IN
• DROP IN FEV1 OF MORE BRONCHOPULMONARY
THAN 15% AFTER EXERCISE ASPERGILLOSIS
• BRONCHIAL CHALLENGE
TEST WITH MANNITOL IS
SENSITIVE
MANAGEMEN
T:
 MANAGEMENT:
AIM IS TO MAINTAIN COMPLETE CONTROL-WHERE THERE ARE NO
DAYTIME SYMPTOMS, NO NEED FOR RESCUE MEDICATION, NO
LIMITATION OF ACTIVITIES, NO NOCTURNAL SYMPTOMS, NO
EXERCEBATIONS AND NORMAL LUNG FUNCTIONS

PATIENT EDUCATION- ON THE USE OF MDI

AVOIDANCE OF AGGRAVATING FACTORS

PHARMACOLOGICAL
MANAGEMENT:
HOW TO USE A PEAK
EXPIRATORY FLOW
METER
PEAK EXPIRATORY FLOW RATE:

• IT BASICALLY DETERMINES HOW FAST AND HARD CAN A PERSON EXHALE AFTER FULL INSPIRATION
• IS AFFECTED BY FULLNESS OF:
-fullness of the preceding inspiration
-caliber of the large airways
-strength of expiratory muscles
-voluntary effort
• PREDOMINANTLY ASSESSES Large airway caliber and underestimate the effect of asthma in the small airways
• Validity depends on maximal effort
• A peak expiratory flow meter is the device that is used
• Value expressed in L/min
How to use a peak
expiratory flow meter

Tool used in diagnosis and assessment of asthmatic patients

Indications:

• severity & response to treatment in acute asthmatic attack

• Assess severity and monitoring of control in chronic persistent asthma
• Assess reversibility of lower airway obstruction
• Assist differentiation from asthma and COPD
• Assess home monitoring of symptoms and control of asthma
 Patient to stand up
Set marker to zero for maximum
expiratory effort

How to use
a peak Take big breath
Hold meter and
place mouthpiece in
expiratory mouth

flow meter Exhale through

Ensure good seal meter as forcefully
with lips as possible giving
peak expiratory flow
How to use a 1 2 3 4
peak expiratory Take reading three Use graph to Graph gives Use patients score as

flow meter
times and record determine predicted predicted mean- a benchmark
highest reading PEF, you need to individuals may be
know gender, age higher or lower
and height for this
METHODS USED TO CALCULATE OR
DETERMINE THE VALUES:
• WITH TECHNOLOGY THE ARE PEAK EXPIRATORY FLOW METER CALCULATORS ON OUR PHONE…..JUST
PUT ON DATA AND GET THE READINGS

• THE ARE VARIOUS FORMULAS USED

- Children PEFR = ((Height in cm - 100) x 5) + 100
-Adult Men = (((Height in m x 5.48) + 1.58) - (Age x 0.041)) x 60
-Adult Women = (((Height in m x 3.72) + 2.24) - (Age x 0.03)) x 60

• CAN STILL OPT FOR THE TRADITIONAL WAY OF DETERMINING IT

-will need the chart as in the previous slide, know patient gender, age and height in centimeter
-determine the estimated value for that patient (demoninator)
-then use the highest reading obtained (numerator)
thus numerator in L/min/denominator in L/min x100= ur value in %
METER
DOSE
INHALE
R
HOW TO USE
MDI

Shake inhaler to mix medication and propellant

Remove cap and check for foreign bodies inside
inhaler

Hold in upright position

Exhale fully

Place lips closely around mouthpiece

Activate inhaler by pressing down on canister
while taking in a slow deep breath.

Take one puff at a time

After breathing in medication, hold breath for
10 seconds

Wait a minute

Repeat if second puff is required

Wash mouth after inhaling corticosteroids
ASSESSMENT OF SEVERITY OF
ACUTE ASTHMA
ASSESSMENT OF SEVERITY OF
CHRONIC ASTHMA:
 Less co-ordination required

Increase deposition of medication in lungs

Use in below instances:

WHAT • Children less than 5
• Less than 3: spacer fitted to facemask
ABOUT • 3-5 years: small volume spacer (250-300ml) with
SPACERS? mouthpiece.
• Children older than 5-large vol. spacer (500ml) with
mouthpiece
• Adults unable to use MDI correctly
• Adults and children on inhaled cortocosteroids to
maximise benefit and reduce systemic absorption
and local side effects eg dysphonia/candidiasis