1. Asthma ( Part 1 ) Dr.kassim.M.sultan F.R.C.P

2. Objectives: 1-Define asthma 2-Identify its aggravating factors 3-Describe its clinical features 4-Illustrate ways of diagnosis 5-Manage a straight case of asthma

3. Asthma: Chronic inflammation and increase hyper- responsiveness ( the tendency to contract too easily and too much in response to triggers that have little or no effect on normal individuals ).

5. Aggravating factors: 1-Atopy ( cats, dogs, cockroaches, horse, house dust mite, fungii ). 2-Drugs ( aspirin, B-blockers, non steroidal anti inflammatory ). 3-Allergic rhinitis. 4-Sinusitis.

6. Clinical features: Recurrent episode of chest tightness. shortness of breath. Cough. Wheeze. The above symptoms get worse during the night and early morning.

7. Physical examination: May be normal, hyperinflation, diffuse expiratory rhonchi and prolong expiratory phase and cyanosis in severe asthma.

8. Chest Hyperinflation

9. Central cyanosis

10. Diagnosis: 1-Clinical history. 2-Spirometer (reduced FEV1 and reduced FEV1/FVC less than 70% ) and reversibility test. 3-Peak flow meter. 4-Chest X-ray ( for suspected pneumothorax ). 5-Sputum ( eosinophil count ). 6-Exhaled nitric oxide concentration.

11. Spirometer

12. Peak flow meter

13. Complication: 1-Pnumothorax. 2-Lung collapse. 3-Superadded infection. 4-Respiratory failure.

14. Management: 1-Avoidance of aggravating factors. 2-Inhaled ( short acting B2-agonist salbutamol …) 3-Inhaled steroid (beclomethasone, fluticasone and budesonide ). 4-Oral leukotriene receptors antagonist (Montelukast). 5-Inhaled combination of long acting B2-agonist (formetrol and salmetrol ) with steroid. 6-Systemic steroid.

15. Inhaler

16. Management of acute sever asthma: 1-Oxygen. 2-High dose inhaled bronchodilators through a spacer or nebulizer ( ipratropium bromide and short acting B2-agonist ). 3-Systemic corticosteroid. 4-If the patient is not improving and is developing: Exhaustion, confusion, drowsiness, coma and respiratory arrest, these features are indicators for assisted ventilation.

18. Nebulizer

19. Summary: 1-Asthma is inflammatory disease. 2-Associated with cough, shortness of breath and wheeze. 3-Diagnose by history, FEV1with reversibility test and PEF. 4-Management by avoid aggravating factors, O2, inhaled bronchodilators, inhaled steroid and systemic steroid according to the severity of the condition.

20. Thanks for your listening