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•MUHAMMAD SAALIM ROLL # S08-54 •AMANAT ALI ROLL # S08-58
Chronic disease of the airways that may cause
Wheezing Breathlessness Chest tightness Nighttime or early morning coughing
Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.
Chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are associated with widespread but variable airflow obstruction that is reversible either spontaneously, or with treatment.
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Intrinsic asthma Extrinsic asthma Nocturnal asthma Bronchial asthma Occupational asthma Silent asthma Seasonal asthma Exercise induced asthma
Genetic characteristics Occupational exposures Environmental exposures
SOB Wheezing Chest tightness Tachypnea (>25/min) Tachycardia (>110/min) Paradoxical pulse Use of accessory muscles of respiration Blue color of the skin & nails .
Three major changes: -Increase mucous production air tubes clog up -Inflammation of air way cells air tubes swell -Tightening of muscles around air tubes Air tubes narrowing & hard to breathe .
medical emergency life-threatening episode of airway obstruction an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and steroids. .
which leads to acidosis. The lung failure means that oxygen can no longer be provided. Same symptoms as in normal asthma attack Complications include cardiac and/or respiratory arrest. . carbon dioxide can no longer be eliminated.
PFR (Peak flow rate) FVC Forced Vital Capacity (FVC) is the volume of air that can forcibly be blown out after full inspiration. an important measure of pulmonary function 3. measured in liters. PFT (Pulmonary Function Test) FEV (forced expiratory volume) The volume of air that can be forced out taking a deep breath. .
oral steroids Step down: When stable for at least 3 months – reduce or stop oral steroids first. Residual volume: Amount of air that stays in the lungs even after max. Tidal volume (TV) Tidal volume (TV) is the specific volume of air drawn into. the lungs during normal tidal breathing. measured in liters per minute. expiration. PEF(PEF) is the maximal flow (or speed) achieved during the maximally forced expiration initiated at full inspiration. and then expired out of. Total Lung Capacity (TLC) Total Lung Capacity (TLC) is the maximum volume of air present in the lungs. Step up: If uncontrolled at any severity level. .
8 L 500 ml 6L Females 3.Measurement Approximate Value Males Forced Vital Capacity (FVC) Tidal volume (Vt) Total lung capacity (TLC) 4.7 L .7 L 390 ml 4.
Symptoms Coughing Wheezing Shortness of breath Chest tightness Symptom Patterns Severity Family History .
particularly at night Awakened by coughing Coughing or wheezing after physical activity Breathing problems during particular seasons Coughing. or chest tightness after allergen exposure Colds that last more than 10 days Relief when medication is used . wheezing. Troublesome cough.
eczema. or other allergic skin conditions . Wheezing sounds during normal breathing Hyperexpansion of the thorax Increased nasal secretions or nasal polyps Atopic dermatitis.
Peak expiratory flow (PEF) Inexpensive Patients can use at home May be helpful for patients with severe disease to monitor their change from baseline every day Not recommended for all patients with mild or moderate disease to use every day at home Effort and technique dependent Should not be used to make diagnosis of asthma .
Allows patient to assess status of his/her asthma Persons who use peak flow meters should do so frequently Many physicians require for all severe patients .
Zone Reading Description Green 71-100% of normal PFR Asthma is under good control. It may mean normal PFR respiratory airways are narrowing and additional medication may be required Red <50% Indicates a medical emergency. . Yellow 50-70% of Indicates caution. normal PFR Severe airway narrowing may be occurring and immediate action needs to be taken. This would usually involve contacting a doctor or hospital.
Spirometry Recommended to do spirometry pre.and post.use of an albuterol MDI to establish reversibility of airflow obstruction > 12% reversibility or an increase in FEV1 of 200cc is considered significant Obstructive pattern: reduced FEV1/FVC ratio Restrictive pattern: reduced FVC with a normal FEV1/FVC ratio .
then for 5-10 minute intervals over the next 20-30 minutes looking for post-exercise bronchoconstriction . Spirometry Can be used to identify reversible airway obstruction due to triggers Can diagnose Exercise-induced asthma (EIA) or Exercise-induced bronchospasm (EIB) by measuring FEV1/FVC before exercise and immediately following exercise.
Methacholine challenge Most common bronchoprovocative test in US Patients breathe in increasing amounts of methacholine and perform spirometry after each dose Increased airway hyperresponsiveness is established with a 20% or more decrease in FEV1 from baseline at a concentration < 8mg/dl May miss some cases of exercise-induced asthma .
Diagnostic trial of anti-inflammatory medication (preferably corticosteroids) or an inhaled bronchodilator Especially helpful in very young children unable to cooperate with other diagnostic testing There is no one single test or measure that can definitively be used to diagnose asthma in every patient .
Mild (no admission) Altered consciousness Physical exhaustion Talks in Pulsus paradoxus Wheeze on ascultation Use of accessory muscles SaO2 Mod (may need Severe (need admission) admission) No No Sentence Not palpable Present Absent >93% >60% No No Phrases May be palpable Present Moderate 91-93% 40-60% Yes Yes Words Palpable Silent chest Marked 90% & < <40% PFR .
Medications come in several forms. Two major categories of medications are: Long-term control Quick relief .
Taken daily over a long period of time Used to reduce inflammation. relax airway muscles. and improve symptoms and lung function Inhaled corticosteroids Long-acting beta2-agonists Leukotriene modifiers Mast cell stablizer .
Used in acute episodes Generally short-acting beta2agonists Anticholinergic drug .
Butekyo Method Simple breathing technique Studied in many clinical trials No side effects Brochial Thermoplasty Deliver thermal energy to airway walls Smoking Weight Reduction .
including exercise Maintain pulmonary function as close to normal levels as possible Prevent asthma exacerbations Avoid adverse effects from asthma medications Prevent asthma mortality . Achieve and maintain control of symptoms Maintain normal activity levels.
Develop with a physician Tailor to meet individual needs Educate patients and families about all aspects of plan Recognizing symptoms Medication benefits and side effects Proper use of inhalers and Peak Expiratory Flow (PEF) meters .
Describes medicines to use and actions to take .
Peak flow >50-75% of predicted or best No features of acute severe asthma Increasing symptoms Treat at home but response to t/m must be assessed before doctor leaves .
.Treatment: High-flow oxygen if available Salbutamol or terbutaline via large volume spacer (4-6puffs each inhaled separately. dose repeated every 10-20min if necessary) or nebuliser Monitor response 15-30min after nebulisation Give oral prednisolone 40-50mg daily for atleast 5days and step up usual t/m.
Follow up: Monitor symptoms and peak flow Set up asthma action plan Review in surgery within 48hrs .
.Cannot complete sentences in one breath Pulse > 110 beats/min Respiration > 25 breaths/min Peak flow 33-50% of predicted or best Seriously consider hospital admission if more than one of above features present.
dose repeated every 10-20min if necessary) or nebuliser (oxygen driven) Oral prednisolone 40-50mg daily for atleast 5days (or IV hydrocortisone 400mg daily in 4 divided doses) Monitor response 15-30min after nebulisation .Treatment: High flow oxygen if available Salbutamol or terbutaline via large volume spacer (4-6puffs each inhaled separately.
If symptoms have improved. . respiration and pulse setting and peak flow >50%: Step up usual t/m & continue prednisolone for atleast 5days. If any signs of acute asthma persist: Arrange hospital admission While awaiting ambulance repeat nebulised beta 2 agonist and give with nebulised ipratropium 500ug.
Follow up: Monitor symptoms and peak flow Set up asthma action plan Review in surgery within 24hrs Modify t/m a review .
arrythmias. exhaustion. confusion or coma Peak flow <33% of predicted or best Arterial oxygen saturation <92%. hypotension.Silent chest Cyanosis Feeble respiratory effort (slow) Bradycardia. Arrange immediate hospital admission .
give 1puff of beta 2 agonist using large volume spacer and repeat 1020 times. .Treatment: Oral prednisolone 40-50mg daily for atleast 5days (or IV hydrocortisone 400mg daily in 4 divided doses) (immediately) Oxygen driven nebuliser in ambulance Nebulised beta 2 agonist with nebulised ipratropium Stay with patient until the ambulance arrives If nebuliser not available.
the presence of any should alert the doctor. Imp: patients with severe or life threatening attacks may not be distressed and may not have all these abnormalities. .
Too breathless to talk Too breathless to feed R/R 50 b/min Use of accessory muscles of respiration PFR < 50% .
Cyanosis Silent chest Poor respiratory effort Exhaustion Reduced level of consciousness PFR < 33% .
I: The instructions can vary according to which delivery system is being used.DIPS [Dosage. and some require capsules to be inserted into the device).Priming. Special Instructions] D: Is the patient going to be using 1 or 2 inhalations? If a bronchodilator and maintenance medications are prescribed. some are breath-actuated. P: 2 to 4 sprays in the air S: (eg. . Instructions.
The health-care provider should evaluate inhaler technique at each visit. .
Spacers can help patients who have difficulty with inhaler use and can reduce potential for adverse effects from medication .
Machine produces a mist of the medication Used for small children or for severe asthma episodes No evidence that it is more effective than an inhaler used with a spacer .
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