นส. นุชนาถ ตั้งเวนิช เจริญสุข รหัส

2 A chronic inflammatory disorder of the airway Airway hyperresponsiveness Recurrent episodes of wheezing, coughing and shortness of breath Widespread, variable and often reversible airflow limitation Definition

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INFLAMMATION Risk Factors (for development of asthma) Airway Hyperresponsiveness Airflow Limitation Symptoms- (shortness of breath, cough, wheeze) Mechanism

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6 Risk factor  Allergens  Occupational  Genetics  Respiratory infections  Environmental exposures

7 Diagnosis History and patterns of symptoms attack or recurrent episodes of wheezing? troublesome cough, worse particularly at night or on awakening? cough after physical activity (e.g. playing)? breathing problems during a particular season (or change of season)? use any medication (e.g. bronchodilator) when symptoms occur? Is there a response?

8 Diagnosis Measurements of lung function

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Classification of Asthma Severity STEP 4 Severe Persistent STEP 3 Moderate Persistent STEP 2 Mild Persistent STEP 1 Intermittent Symptoms Nighttime Symptoms PEF CLASSIFY SEVERITY Clinical Features Before Treatment Continuous Limited physical activity Daily Use  2-agonist daily Attacks affect activity >1 time a week but <1 time a day < 1 time a week Asymptomatic and normal PEF between attacks Frequent >1 time week >2 times a month <2 times a month <60% predicted Variability >30% >60%-<80% predicted Variability >30% >80% predicted Variability 20-30% >80% predicted Variability <20%

11 Therapy at each stage of Asthma

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13 Patients are not detected Do not seek medical attention No access to health service Missed diagnosis (bronchitis, LRTI) The treatment Gap in Asthma