Presentation by Dr. S.K Jindal on Bronchial Asthma/अस्थमा / दमा | Jindal Chest Clinic

1
BRONCHIAL ASTHMA ?????? / ???
S. K. Jindal Professor and Head Department of
Pulmonary Medicine Postgraduate Institute of
Medical Education and Research,
Chandigarh Jindal Chest Clinic, Chandigarh
2
Asthma

• Chronic Inflammatory (allergic) disorder of
  airways characterized by Episodic, Reversible
  bronchospasm (i.e narrowing of airways)
  resulting from an exaggerated broncho-constrictor
  response to various stimuli (triggers)

3
(No Transcript)
4
Prevalence of asthma

• Globally, asthma affects 10 children 5-7
  adults. Highest in NZ, Low in Fiji
  1
• India Prevalence between 2-3 of population.
• Very high total burden.
• Adults
• Chowgule 1998 Mumbai M 3.8 W 3.4
• Jindal 2000 Chandigarh M 4 W
  1.27
• Aggarwal 2006 Multi-centre M
  2.2, W 2.6
• Jindal 2012 Multi-centre
  2.1
• Children
• Chhabra 1998 Delhi
  Current 11.6
• Gupta 2001 Chandigarh Boys
  2.6, Girls 1.9
• Respir symptoms 31

5
INSEARCH Indian Study on Epidemiology of Asthma,
Respiratory symptoms and Chronic bronchitis
Aggarwal 2006
Multi-centre M 2.2, W 2.6 Jindal
2012 Multi-centre 2.1
6
????? Symptoms
???? ??? ????? Breathlessness
????? Cough
???? ?? ????, ??????? Wheezing
???? Sputum
???? ??? ???? Chest pain
??? ??? ???? ? ??? Sleep difficulties
????? ?????? Serious disease
7
Factors Influencing Occurrence of asthma

• Genetic Heredity (36-60)
• Environmental influences
• Exposure to allergens
• Early exposure
• Smoking and pollution
• Infections and infestations
• Foods and nutrition
• Infant feeding

8
???? Triggers
??????? Infections
??? ?? ???? ?? Grass Pollens
???, ????, ????? Dust, smoke, insects
?????? ?? ???? Tobacco Smoke
?????? ???? Mental stress
???????, ?????? Exercise, sports
????? Drugs
?????? ??? ???????? Temperature change
9
Tobacco Smoking
10
Indoor Air Pollution

• Biomass Fuel Combustion
• Environmental Tobacco Smoke (ETS)
• Others
• Environmental
• Biological (bacterial, fungal)
• Construction related
• Consumer products
• House dust (etc.)

11
PASSIVE SMOKING

• Environmental Tobacco Smoke Exposure
• Second-hand smoking, Involuntary Smoking
• In-Utero Exposure
• Maternal smoking or Maternal ETS exposure
• 
  (Tertiary smoking)
• Risk of development of Poorer lung function
  Asthma ?
• Others (COPD)

12
??? ?? ????? How to manage
????? ??????, ???????, ???????? Drugs Inhalers, Tablets, Injections
?????? ?? ???? Avoid Triggers
?????? ?? ???? Treatment of allergy
13
Anti-asthma Drugs

• Controllers
• Glucocorticoids Inhaled/Systemic
• Inhaled long acting ?-2 agonists
• Oral theophyllines
• Leukotriene receptor antagonists
• Cromones
• Oral long acting ?-2 agonist
• Relievers
• Rapid acting ? 2 agonists
• Oral glucocorticoids
• Inhaled anti-cholinergics
• Oral short acting ?2 agonists

14
(No Transcript)
15
?????? ?????? Why inhalers?
?? ????? Minimal dose
??????? ?????? ???? No systemic effect
????? ????? Early relief
?? ?????? Few harms
16
(No Transcript)
17
(No Transcript)
18
From www.use-inhalers.com
19
??? ?? ???? Avoiding asthma
?????? ?? ??? ???? Avoid triggers
???? ?? ???? ???? Early treatment
??????? ?? ??? No misconceptions
20
?? ?? ???? ????? What to do at home?
??? ????? ???? ???? ??????? ?? ??? ??? Keep away from dust gathering articles
???????? ? ???? Do not smoke
???? ?? ??? ??? Keep away from smoke
????? ?? ???? ??? ??????? Safe dusting and cleaning
????? ??????? ?? ??? ??? Keep away from pets
21
???? ?? ?????? ??? Acute attack
?????? ??? Do not panic
?????? ???? ???? Do not ignore
?????? ?? ???? ????? ?? Take prescribed drugs
?????? ??? ?????? ???? Increase inhalers
??? ???????? ?? ??????????? ? ?? Do not take steroids or antibiotics yourself
?????? ?? ???? ???? Consult your doctor
22
??? ????? ?? ??? ???? ????? Who all should know
????????, ????? ??? ????????? Well wishers, friends and relatives
????? ??? ??????? School teachers
????? ??? ?????? Colleagues at work
?????? In-laws
23
??? ?????????? Wrong ideas
???????? ??? Infectious
????? ??? Curse
?????? ?? ??? Habit forming inhalers
?????? ???? Permanent cure
24
??? ????? ????????? Special situations
???? ?? ??????? ????? Things to eat
??????? ?? ?????? Exercise and games
???? ?? ?????????? Marriage / pregnancy
???? ??? ??????, ???????, ??? Other diseases like diabetes, hypertension
25
??? ??? ???? Asthma and marriage
?????? ???? Regular Treatment
?????? ??? ??????? Knowledge of in-laws
?????????? ??? ???? Pregnancy - treatment
????? ???? ??? ??????? Lactation in newborn
????? ??? ??? Asthma in children
26
?????????? ???? Important issues
???? ?? ???????? Cure or control
??????? ?? ???? Drugs versus avoidance
????????? ?? ???????? ?? ?????? Effects on health and longevity
27
(No Transcript)
28
Asthma Action Plan Zones

• Green Zone All Clear/Breathing Good/Go
• No asthma symptoms and/or
• Peak flow 80-100 Predicted or Personal best
• Yellow Zone Caution/Slow Down
• Some asthma symptoms and/or
• Peak flow 50-80 Predicted or Personal best
• Red Zone Medical Alert/Stop
• Severe asthma symptoms and/or
• Peak flow lt 50 Predicted or Personal best

29
Some top achievers with asthma
??? ?? ?????? ?? ????? ?? ???? ?? ??????? ????
??? ???
30
SUMMARY

• Asthma is a common and important health problem.
  
• It is important to look for triggers/ causes of
  asthma for an effective control.
• Airway inflammation, a prominent feature in
  asthma, needs to be targeted with effective
  medication (primarily inhalational) to
• achieve asthma control.

31

• THANK YOU