1. Bronchial Asthma
Dr. Saraswathi Ramesh

2. Definition
Obstructive pulmonary disease characterised by hyper-responsiveness of bronchial mucosa causing narrowing of the bronchi in response to a wide range of stimuli resulting in cough, wheeze, thightness of chest and shortness of breath which is worst during night

3. Types Atopic or Early onset / Extrinsic
Late onset (Non-atopic) / Intrinsic

4. Applied Anatomy & Physiology
Upper Respiratory tract
Nose, Nasopharynx, Larynx
Lined by vascular mucous membrane with ciliated epithilium
Lower Respiratory tract
Trachea, bronchi
Lined by ciliated epithilium as far as terminal bronchioles

5. Applied Anatomy & Physiology
Larynx and large bronchi are richly supplied with sensory nerve receptors involved in the cough reflex.
Acinus is the gas exchange unit of the lung and comprises branchning respiratory brochioles leading to clusters of alveoli

6. Incidence 10-20% population Prevalence increasing
Mortality due to asthma unchanged inspite of medical advances

7. Aetiology Allergens Skin test positive Skin test negative
Early Onset
Extrinsic
Atopic
Infection
Exercise
Environment
Occupation
Drugs
Emotion
Late Onset
Intrinsic
Non-atopic
Skin test positive
Family history of allergic disorders
Skin test negative
Family history absent

8. Clinical Features Episodic Asthma No symptoms between episodes
Paroxysms of wheeze and dyspnoea
Triggered by allergens, exercise, viral infections, eg. cold

9. Clinical Features Severe Acute Asthma
Was known as ‘status asthmaticus’
Life-threatening situation
Orthopnoea
Unproductive cough with respiratory distress
Tachycardia, pulsus paradoxus, sweating, central cyanosis

10. Clinical Features Chronic Asthma
Chest tightness, wheeze, breathlessness on exertion
Spontaneous cough and wheeze during night
Episodes of severe acute asthma with respiratory infection

11. Clinical Features
During the attack the chest is held in the position of full inspiration
Decreased breath sounds with ronchi
‘silent chest’ during severe attack
‘pigeon-chest’ deformity

12. Investigation X-ray Chest Pulmonary function tests
FEV1, VC, PEF
Arterial blood gases
PaO2, PaCO2
Skin hypersensitivity tests

13. Preventive Measures Pollens
Try to avoid exposure to flowering vegetation.
Keep bedroom windows closed
Mites in house dust
Vacuum clean mattress daily
Shake out blankets daily
Dust bedroom thourghly
Animal dander
Avoid contact with dogs, cats, horses or other animals

14. Preventive Measures Feathers in pillows or quilts
Substitute latex foam pillows and terylene quilts
Drugs (eg, beta-adrenoceptor antagonists)
Avoid all preperations of relevant drugs
Foods
Identify and eliminate from diet
Industrial chemicals
Avoid exposure or change occupation

15. Management Hyposensitization
Subcutaneous injection of initially very small, but gradually increasing doses of extracts of allergens

16. Chronic persistent asthma5
4 plus regular oral steroids 4
3 plus regular bronchodilators 3
High dose inhaled corticosteroids 2
Regular inhaled corticosteroids – small dose 1
Occasional short-acting-Beta2-adrenoceptor agonists

17. Acute Severe Asthma Oxygen
High doses of inhaled beta2 adrenoceptor agonists
Systemic steroids
Assisted ventillation

18. THANK YOU