1. นส. นุชนาถ ตั้งเวนิช เจริญสุข รหัส 490940-660

2. 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

3. 3

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

5. 5

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

7. 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. 8 Diagnosis Measurements of lung function

9. 9

10. 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. 11 Therapy at each stage of Asthma

12. 12

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