BRONCHIAL ASTHMABRONCHIAL ASTHMA

DR.K.PREETHIDR.K.PREETHI

RESPIRATORY SYSTEMRESPIRATORY SYSTEM

TRACHEATRACHEA PAIR OF BRONCHIPAIR OF BRONCHI BRONCHIOLESBRONCHIOLES

ASTHMA DEFINITIONASTHMA DEFINITION

EpisodicEpisodic ReversibleReversible BronchoconstrictioBronchoconstrictio

nn Due to increased Due to increased

responsiveness to responsiveness to various stimulivarious stimuli

COMMON TRIGER FACTORSCOMMON TRIGER FACTORS

Pollen from flowersPollen from flowers Dust miteDust mite Pet danderPet dander MoldMold

PATHOGENESISPATHOGENESIS

Following the entry of antigen Following the entry of antigen various mediators of inflammation various mediators of inflammation are released are released

Mast cellMast cellNeutrophilsNeutrophilsEosinophilsEosinophilsLymphocytesLymphocytes

PATHOGENESISPATHOGENESIS

ASTHMATIC AIR WAYASTHMATIC AIR WAY

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

Contraction of Contraction of smooth musclesmooth muscle

Vascular Vascular congestioncongestion

Edema of bronchial Edema of bronchial wallwall

Thick secretionsThick secretions

SYMPTOMSSYMPTOMS

CoughingCoughing WheezingWheezing Chest tightnessChest tightness Shortness of breathShortness of breath

SIGNSSIGNS

Increased heart Increased heart raterate

Increased Increased respiratory raterespiratory rate

Wheezing on Wheezing on auscultationauscultation

PHARMOCOLOGYPHARMOCOLOGY

DRUGS THAT INHIBIT SMOOTH DRUGS THAT INHIBIT SMOOTH MUSCLE CONTRACTIONMUSCLE CONTRACTION

BRONCHODILATORS -TheophyllineBRONCHODILATORS -TheophyllineBETA 2 AGONIST BETA 2 AGONIST Short acting -Albuterol ,TerbutalineShort acting -Albuterol ,TerbutalineLong acting -SalmeterolLong acting -Salmeterol

INHIBITORS OF INHIBITORS OF INFLAMMATIONINFLAMMATION

CORTICOSTEROIDSCORTICOSTEROIDSMAST CELL STABILIZERSMAST CELL STABILIZERS

MANAGEMENTMANAGEMENT

ROUTES OF ADMINISTRATIONROUTES OF ADMINISTRATION InhalationalInhalationalOral routeOral route Intravenous routeIntravenous route

MEDICAL MANAGEMENTMEDICAL MANAGEMENT

MILDINTERMITENT

ASTHMA

SYMPTOMS

<2TIMES/WEEK

AWAKENING AT NIGHT

<2TIMES/MONTH

SHORT ACTINGB2 AGONIST

MILD PERSISTANTASTHMA

SYMPTOMS

>2TIMES/WEEK

AWAKENING ATNIGHT

>2TIMES /MONTH

SHORT ACTING&LONG ACTINGB2 AGONISTLOW DOSE

STEROID

MODERATE PERSISTANT

ASTHMA

SYMPTOMS

DAILY

AWAKENING ATNIGHT

>1/WEEK

INHALED STEROIDLONG ACTING SALMETEROL

2 PUFF/BD

SEVERE PERSISTANT

ASTHMA

SYMPTOMS PRESENT

CONTINOUSLY

FREQUUENTNIGHT

AWAKENING

HIGH DOSE STEROID

LONG ACTINGBRONCHO DILLONG TERM

ORAL STEROID

PRE OPERATIVE STEPSPRE OPERATIVE STEPS

ASSESS THE ASSESS THE RESPIRATORY RESPIRATORY STATUS IN SUPINE STATUS IN SUPINE POSTUREPOSTURE

SHIFT THE SHIFT THE PATTIENT IN PATTIENT IN WHEEL CHAIRWHEEL CHAIR

KEEP VENFLON IN KEEP VENFLON IN POSITIONPOSITION

INHALERSINHALERS

MEDICAL DEVICE MEDICAL DEVICE USED TO DELIVERUSED TO DELIVER MEDICATIONS IN MEDICATIONS IN

TO THE BODY TO THE BODY VIA LUNGSVIA LUNGS

METERED DOSE INHALERMETERED DOSE INHALERDRY POWDER INHALERDRY POWDER INHALER

INSTRUTION TO USEINSTRUTION TO USE

Remove cap from mouth piece .Shake well.Remove cap from mouth piece .Shake well.

Sit up straight , lift the chin up.Sit up straight , lift the chin up.

Take few deep breathTake few deep breath

Put the mouth piece in mouth, seal with lipsPut the mouth piece in mouth, seal with lips

As you start to breathe in simultaneously As you start to breathe in simultaneously press on the inhaler to release one puff.press on the inhaler to release one puff.

For the second puff wait for 30 minutes.For the second puff wait for 30 minutes.

NEBULIZERNEBULIZER

It is a device used It is a device used to administer to administer medication in the medication in the form of mistform of mist

PARTS OF NEBULIZERPARTS OF NEBULIZER

Mouth piece or Mouth piece or maskmask

Cup to hold the Cup to hold the medicationsmedications

Tshaped partTshaped part Thin plastic tubeThin plastic tube MachineMachine

INSTRUCTION TO USEINSTRUCTION TO USE

Measure the right amount of Measure the right amount of medications.medications.

Attach the mouth piece or mask to the Attach the mouth piece or mask to the medication cap. medication cap.

Attach the cap to the machine using Attach the cap to the machine using long clear tubing.long clear tubing.

Turn the machine on.Turn the machine on.

Put the mouth piece or the face mask.Put the mouth piece or the face mask.

Take slow deep breath in and out Take slow deep breath in and out inhaling the mist.inhaling the mist.

Hold each breath 1-2 sec before Hold each breath 1-2 sec before breathing out.breathing out.

All the medication must to be inhaled All the medication must to be inhaled with in 5-10 minutes.with in 5-10 minutes.

CARE OF THE NEBULIZERCARE OF THE NEBULIZER

After each use take apart all the parts.After each use take apart all the parts.Rinse the mouth piece or mask,T Rinse the mouth piece or mask,T

connection medication cap.connection medication cap.Allow it to dry.Allow it to dry.Once or twice a week , after rinsing Once or twice a week , after rinsing

soak the parts in antiseptic solution.soak the parts in antiseptic solution.Clean the surface of the machine with Clean the surface of the machine with

damp cloth.damp cloth.

ACUTE SEVERE ASTHMAACUTE SEVERE ASTHMAmanagementmanagement

MANAGEMENT MANAGEMENT

Back restBack restO2 by mask or cannula 2-4 lit/minO2 by mask or cannula 2-4 lit/minBroncho dilatorsBroncho dilatorsSystemic steroidsSystemic steroids IV methyl prednisoloneIV methyl prednisoloneOral steroidsOral steroidsNebulised salbutamolNebulised salbutamolHydration with iv fluids.Hydration with iv fluids.