management of asthma seminar
TRANSCRIPT
MANAGEMENT OF
BRONCHIAL ASTHMA
NOOR HAFIZAH BINTI HASSAN 2007287236
REFERENCES
1. GLOBAL INITIATIVE FOR ASTHMAGLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTIONUPDATED 2009
2. GUIDELINES ON MANAGEMENT OF ADULT ASTHMAMALAYSIAN THORACIC SOCIETY2002
GOALS OF MANAGEMENT1. ACHIEVE AND MAINTAIN CONTROL OF
SYMPTOMS2. MAINTAIN NORMAL ACTIVITY LEVEL,
INCLUDING EXERCISE3. MAINTAIN PULMONARY FUNCTION AS CLOSE
TO NORMAL AS POSSIBLE4. PREVENT ASTHMA EXACERBATION5. AVOID ADVERSE EFFECT FROM ASTHMA
MEDICATIONS6. PREVENT ASTHMA MORTALITY
1. DEVELOP PATIENT/DOCTOR RELATIONSHIP
2. IDENTIFY AND REDUCE EXPOSURE TO RISK FACTORS
3. ASSESS, TREAT AND MONITOR ASTHMA
4. MANAGE ASTHMA EXACERBATION
APPROACH TO MANAGEMENT
1. DEVELOP PATIENT/DOCTOR RELATIONSHIP
• Aim of partnership guided self-management
• Patient education:– Nature of asthma– Preventive measures/avoidance of triggers– Drugs used & their side effects– Differentiate between “reliever” and “controller”– Proper use of inhaler devices– Proper use of peak flow meter– Self management plan– Recognize features of worsening asthma– Dangers of non prescribed self medication
Peak Flow Chart
People with moderate or severe asthma should take readings:– Every morning– Every evening– After an
exacerbation– Before inhaling
certain medications
Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma Created and funded by NIH/NHLBI
CONTROLLER MEDICATIONS & THEIR SIDE EFFECTS
RELIEVERS MEDICATIONS & THEIR SIDE EFFECTS
2. IDENTIFY & REDUCE EXPOSURE TO RISK FACTORS
• Factors that may precipitate asthma attacks:o Indoor allergens: domestic mites, furred animal,
cockroaches, and fungi.o Outdoor allergens: pollens and molds.o Smoking: active or passiveo Atmospheric pollutantso Day-to-day triggers: exercise and cold airo Occupational exposureo Food & food additiveo Drugs: aspirin, NSAIDs, and B-blockero Others: obesity/ influenza vaccine/ emotional stress
a) ASSESSING ASTHMA CONTROL:– To establish patients’ current treatment regimen– Adherence to the current regimen– Level of asthma control
b) TREATING TO ACHIEVE CONTROL– Reliever and controller medications
c) MONITORING TO MAINTAIN CONTROL– Controlled STEP DOWN– Loss of control STEP UP
3. ASSESS, TREAT & MONITOR ASTHMA
Three or more
features of partly
controlled asthma
present in any week
a) Level of asthma control
c) Monitoring to maintain controlo Frequency of health care visit:
1-3/12 after initial visit (dx) every 3/12 thereafter following exacerbation follow up 2/52 to 1/12
o Stepping down: low dose ICS as controller switched to OD dose medium/high dose ICS ↓ 50% within 3/12 ICS + LABA ↓ ICS by 50% + continue LABA. Once control is
maintained ↓ ICS to low dose + stop LABA ICS + controller other than LABA ↓ ICS by 50% or low dose +
stop the combination
o Stepping up: short acting B2 agonist / LABA ICS combination: ICS + rapid and long acting B2 agonist
o Difficult-to-treat asthma: definition: not reaching acceptable control at step 4 confirm diagnosis ensure compliance proper technique of using inhalation devices smoking comorbidities: obesity / OSA / chronic sinusitis / GERD /
psychological disorders consider referral to respiratory physician
4. MANAGE EXACERBATION
• Aim of management: To prevent death To relieve respiratory distress To restore patient’s lung function to the best
possible level as soon as possible To prevent early relapse
• Assessment of severity of attack: Hx taking & physical examination PEF measurement
FEATURES MILD MODERATE SEVERE / LIFETHREATENING
ALTERED CONSCIOUSNESS NO NO YES
PHYSICAL EXAMINATION NO NO YES
SPEECH SENTENCES PHRASES WORD(S)
PULSE RATE < 100 bpm 100-120 bpm > 10 bpm
PULSUS PARADOXUS
ABSENT( < 10 mmHg)
MAYBE PRESENT(10-25 mmHg)
OFTEN PRESENT( > 25 mmHg)
WHEEZING INTENSITY MODERATE LOUD OFTEN QUITE
USE OF ACCESSORY MUSCLE ABSENT MODERATE MARKED
CENTRAL CYANOSIS ABSENT ABSENT PRESENT
ASSESSMENT OF SEVERITY OF ASTHMA EXACERBATION
FEATURES MILD MODERATE SEVERE / LIFE THREATENING
PEFR• after initial use of bronchodilator or % predicted or % personal best
> 80 % 60-80 % < 60 %
O2 SATURATION > 95 % 91-95 % < 90 %
ARTERIAL PO2NO NEED TO DO
ABG > 60 mmHg < 60 mmHg
ARTERIAL PCO2NO NEED TO DO
ABG < 45 mmHg > 45 mmHg
CONTINUE..
b) Pharmacology revisited..
BRONCHIALTONE
BRONCHOCONSTRICTION
BRONCHODILATION
ATP
AC
cAMP
PDE
AMPADENOSINEACETYLCHOLINE
b) Pharmacological treatment
BRONCHIALTONE
BRONCHOCONSTRICTION
BRONCHODILATION
ATP
AC
cAMP
PDE
AMP
B 2 AGONIST
THEOPHYLLINE
ADENOSINEACETYLCHOLINE
THEOPHYLLINEANTI
CHOLINERGIC