Guidelines for asthma management

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GUIDELINES FOR ASTHMA MANAGEMENT
S. K. Jindal www.jindalchest.com
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Wrong Diagnosis

• Chronic Obstructive Pulmonary Disease
• Cardiac asthma
• Upper airway obstruction
• Vocal cord dysfunction
• Sleep apnoea
• Local obstruction by tumours/foreign body
• Hypersensitivity pneumonias
• Infections/Bronchiectasis
• Pulmonary embolism

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All that wheezes isNot AsthmaandAll
asthmadoes not wheeze
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• Case summary
• 40 M, shop owner
• Presenting complaints
• Recurrent episodes of apnea 10 months
• Background
• Frequent cough
• Occasional Breathlessness for 10 years
• No definite h/o wheeze
• h/o loud snoring, no day time somnolence
• No h/o seizures, abnormal behavior
• No h/o stridor (but documented in PGI)

J Assoc Physicians India 2001 49488-90
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• Current Illness Nov 1999 First episode at
  night
• Uneasiness and difficulty in breathing
• Impaired consciousness
• Blue
• Admitted to ER, intubated,
• Recovered with in a day
• Subsequently Five admissions to DMC
• 10 episodes requiring ETT and short term
  mechanical ventilation (few hours to 1 day)
• Normal in between the episodes

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• No response to anti asthma measures
• Very quick reversal on intubation
• Normal lung functions in between
• Documented stridor

VOCAL CORD DYSDFUNCTION
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Disease Association

• Rhino-sinusitis / Polyps
• G.E. Reflux
• Obstructive sleep apnoea
• COPD
• Allergic broncho pulmonary aspergillosis
• Other infections
• Churg-Strauss syndrome / vasculitides
• Psychological problems

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• SS 31M Farmer
• H/o breathlessness, wheezing (episodic)
• mucoid/mucopurulent sputum gt 10 yrs
• Acute severe attacks
• Poor response to asthma tmt.
• H/o ATT in the past (twice)
• Exam Extensive rhonchi crackles
• Haemogram TLC 12000/cum. E 8

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Allergic Broncho Pulmonary Aspergillosis

• Skin test Immediate delayed ve
• Sputum for aspergillus ve
• Serology ve
• Treated with oral CS
• Antifungal tmt ?
• Maintenance tmt ?

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Morphological

• Structural continuity
• Common passage
• Similar/same exposures, insults Inflammatory
  responses

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