BRONCHIAL ASTHMA

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BRONCHIAL ASTHMA

• DR. P. E. ABRAHAM
• CONSULTANT PHYSICIAN ALLERGY SPECIALIST

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Introduction

• Definition
• Asthma is a chronic inflammatory disorder of the
  airways in which many cells and cellular elements
  play a role, in particular mast cells,
  eosinophils, T.Lymphocytes, macrophages,
  neutrophils and epithelial cells

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Introduction contd

• 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 usually associated with wide
  spread but variable airflow obstruction that is
  often reversible, either spontaneously
• The inflammation also causes an associated
  increase in the existing bronchial
  hyper-responsiveness to a variety of stimuli
• Prevalence up to 20 in children
• low in teen ages
• 5-10 of adults

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History

• Intermittency
• Triggers ( aeroallergens, exercise, cold air,
  food)
• Age of onset
• Relief by broncho-dilators
• Nocturnal or early morning symptoms

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Diagnosis

• History alone
• History peak flow variables
• History spirometry broncho-dialtor
  response
• History airway responsiveness

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Differential diagnosis

• Post nasal drip
• Upper airway dysfunction
• Goitre
• Broncho-malacia
• Vocal cord dysfunction
• Hyper-ventilation syndrome
• Obesity

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Risk factors associated with childhood asthma

• Family history
• Atopy
• Diet low omega-3 fatty acid in diet
• Breast fed lt 3 months
• GENETICS

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Investigations

• Spirometry
• -Obstruction at base line
• - FEV1/FVC ratio less than 80
• -Broncho-dilator reversibility
• Peak-flow meter
• -At home monitoring
• -Diagnosis, control monitoring
• -Blood test, culture and sensitivity of sputum

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Mechanical consequences of acute asthma

• Airway narrowing
• Hyperinflation
• Airway closer
• Bronchial challenge testing Direct
• Indirect

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Airway hyper-responsiveness

• Characteristic abnormality of asthma
• Ability of the airways to narrow too easily and
  by too much
• Non-specific
• Asthma
• COPD
• Allergy
• Normal
• LVF

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MANAGEMENT

• Six step asthma management plan
• Asses severity
• Achieve best lung function
• Avoid trigger factors
• Optimize medication programme
• Develop an action plan
• Regular review and education

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Severity or control assessment

• Symptoms
• Symptom frequency and nocturnal asthma
• Morbidity. Eg. Hospitalisation and exacerbation
• Broncho-dilator use
• Peak-flow variability
• Spirometric function

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Severe cases

• - daily symptoms
• - nocturnal or morning symptoms gt once/week
• - usually a hospital admission in last 12 months
  
• /- IPD admission
• - FEV1 lt 60 of predicted
• - waking PEF lt 80 best

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Mild cases

• - occasional symptoms
• - no nocturnal or morning symptoms, hospital
  visits in last 12 months, ICU admission
• - broncho-dilator use lt 2/week
• - FEV1 gt 80 of predicted
• - waking PEF gt 90 recent best.

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Inhaled cortico-steroid treatment

• Prevention
• Dose of steroids
• Mild to moderate
• 750/1000 mEq/day of beclomethasone or 800
  mEq/day of Budesenide beta-agonist when
  required
• Severe asthma
• up to 2000 mEq/day Ist, 2400 mEq/day second
• 500 1000 mEq/ day of Fluticasone propionate
• Side effect of Steroid therapy Growth delayed

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Asthma in pregnancy

• Exacerbations are most frequent between 24 and 36
  weeks.
• Exacerbation during delivery are very uncommon
• Problems in pregnancy due to asthma
• Pre-eclamsia more incidence (2-3)
• Perinatal mortality ( 2 times)
• Pre-term birth ( 30 times) more with steroid
  treated case.
• low birth weight
• increased incidence congenital malformation

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Summary of Asthma in pregnancy

• treat the asthma
• associated with better foetal outcome
• drugs are safe and effective
• benefits of good treatment outweigh the risk of
  under treatment

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Allergic Broncho-Pulmonary Aspergillosis (ABPA)

• History asthma
• Immediate skin test reactivity to aspergillus
  antigen
• Preciopitating serum antibody to antifungative
• Proximal bronchiectasis
• Serum total IgE gt 1000 ng/ml
• Peripheral blood eosinoplils lt 500/cu mm.
• Elevated IgE and IgG to antifungative.
• Lung infiltrates.

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Aspirin Sensitive Asthma

• may be non-atopic
• often severe asthma
• sensitivity to dietary salicylates
• fresh fruits
• vegetables
• Samters triad
• - Asthma
• - Aspirin intolerance
• - Nasal polyp

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Occupational asthma

• Isocynates, formaldehyde anhydrides
• Plicatic acid Carpenters
• Plant products Bakers
• Animal proteins
• Latex
• Pollution fumes
• House dust mites allergens avoidance
• controversial
• efficacy ??
• effective if able to reduce HDM levels lt 3
  mEg/gm
• best

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My observations in management of asthma for the
past 30 years

• Adult asthma
• Childhood asthma
• My management programme
• 4 pillars
• - Diet (50)
• - Homoeopathy
• - Yoga therapy
• - Vita-nutrient therapy

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Dietary management of Asthma

• Triggers
• Source for infection (bronchitis)
• Immunity involvement Sugar
• Night aggravation
• Obesity
• Alkaline and acid food

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Summary of my observations

• Most of the asthma is curable
• - childhood 90 99
• - adult 80 90
• Definition of cure
• Definition of Optimum health
• It is the fundamental right of every individual
  to take full favour from the nature and as
  physicians it is our duty to provide the facility
  for the same

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THANK YOU