1. L de Man Dept of Physiotherapy UFS 2012
Bronchial asthma
L de Man
Dept of Physiotherapy
UFS
2012

2. Definition Asthma is a disease characterised by
a wide variety of resistance to airflow
in the intrapulmonary airways. This can occur in the absence of any other disease that can cause it and is reversible spontaneously or with medication

3. Aetiology and epidemiology
Has a genetic component
Tendency to allergies are inherited
Allergens :
faeces of house mite,
fur of cats, dogs, other animals,
grass pollens
certain foods
Also exercise, air temperature changes , paints, glues, NSAID, ß-blockers, stress, emotional disturbances.
Respiratory tract infection can also trigger attack

5. Aetiology and epidemiology
Extrinsic
Intrinsic
Earlier in life – childhood
Positive family history
Hypersensitivity to allergens
Positive skin-prick test
Occurs intermittent
Improves with age
Seasonal rhinitis and eczema
Occurs later in life
No family history
Allergic features absent
No positive skin-prick test
Occurs persistently
Worsens with age
Commoner in women

6. Pathophysiology Obstruction occurs in the airways due to
Hypertrophy and hyperplasia of the bronchial
smooth muscles
Thickening of the epithelial basement
membrane of the airways
Oedema of the bronchial wall
Eosinophilic infiltration of the bronchial wall
Hypertrophy of the bronchial mucous glands
increase in number of goblet cells

7. Pathophysiology
Leads to narrowing of larger bronchi and plugging of bronchi and bronchioles with viscid
mucus

8. Clinical features Wheeze Breathlessness Chest tightness
Cough that may be paroxysmal
Respiratory rate increased
Expiration prolonged
Use of accessory muscles of breathing
Decreased exercise tolerance

9. Medical management
Preventers
Relievers
Anti-inflammatory drugs (inhaled steroids)to suppress underlying inflammation
Avoidance of allergens!
Drugs that relieve bronchospasm
Inhaled ß2-agonists and anti- cholinergic drugs

10. Chest x-ray
Will show signs of hyperinflation with an acute attack

11. Inhalers

12. Status Asthmaticus
Acute, severe asthma severe wheezing and breathlessness lasting more than 24 hours
Not responding to normal medication.
Potentially life-threatening
Respiratory rate > 25/minute
Tachycardia > 110 bpm
Silent chest
Cyanosis
Disturbance in consciousness

13. Physiotherapy problems
Decreased airflow due to bronchospasm
Dyspnea due to decreased airflow
Tense shoulder girdle due to use of accessory muscles of breathing
Decreased exercise tolerance

14. Physiotherapy treatment
Relieve bronchospasm with inhalation therapy
Dyspnea management – relaxation positions, shoulder girdle relaxation, controlled breathing (relaxed diaphragmatic breathing, inspration and expiration relaxed, expiration prolonged), FET.
Increase exercise tolerance
Correct use of inhaler
Education
Use of peak flow meter for self management

15. Peak flow meter
Measures the fastest rate of airflow with forced expiration in l/min
Patient can use his predicted versus actual reading to indicate the need for treatment
Measure peak flow every day
If reading 60% of personal best, go to doctor
If reading ‹ 60% of personal best, go to emergency room

16. Peak flow meter

17. Peak flow meter Allow one trial attempt to familiarise with device
Deep breathe in, device between lips, keep device level, seal lips tightly around device, blow out as hard as possible.
Take 3 readings immediately after each other
Record best of 3 readings.
See chart to determine predicted peak flow rate for the individual

18. References
Downie,P.A Cash’s Textbook of Chest, Heart and Vascular disorders for Physiotherapists. 4th ed. Mosby , ; Smith,M. & Ball, V Cardiovascular/ Respiratory Physiotherapy. Mosby,