1. BRONCHIAL ASTHMA YOUSEF ABDULLAH AL TURKI MBBS,DPHC,ABFM
Associate Professor
Consultant Family Medicine
King Khalid University Hospital
College of Medicine
King Saud University

2. CASE SCENARIO HOW YOU WILL PROCEED DURING THIS CONSULTATION ?
Khalid 14 years old come to the clinic c/o shortness of breath for one day duration.
He is a known asthmatic patient for more than 8 years, he visited A/E frequently.
His school performance is below average, with frequent absence from school due to his illness.
HOW YOU WILL PROCEED DURING THIS CONSULTATION ?

3. What are your objectives in caring for bronchial asthma patient ?
Prevent troublesome symptoms night and day
Prevent serious attacks
Require little or no reliever medication
Have productive, physical, psychological, and social active lives

4. WHAT IS BRONCHIAL ASTHMA?
Asthma is a CHRONIC INFLAMMATORY disorder of the airways.
Chronically inflamed airways are hyper responsive;
they become obstructed and airflow is limited by bronchoconstriction,mucus plugs, and increased inflammation when airways are exposed to various risk factors.

5. WHAT IS THE PREVALENCE IN SAUDI ARABIA ?

6. The prevalence of asthma among school children in K. S
The prevalence of asthma among school children in K.S.A ( AL Frayh, et al )
Range
4%-23%
Riyadh
10%
Jeddah
12%

7. What is the Pathophysiology?
Trigger Factor
Mast cell
Mediators : histamine,prostaglandin,leukotrienes,as well as cytokines.
Inflammatory cells
Sustained Inflammatory response
Contraction of airway smooth muscles (Bronchoconstriction)

8. Pathophysiology (Cont.)
Airway wall swelling (mucosal edema)
Airway hyper responsiveness
Chronic changes
Hypertrophy of the smooth muscles, thickening of the basement membrane
Airway remodeling
There is good evidence that asthma occurs in families.

9. What are the Triggering Factors?
Domestic dust mites
Air pollution
Tobacco smoke
Occupational irritants
Cockroach
Animal with fur
Pollen

10. Triggering Factors ( cont.)
Respiratory (viral) infections
Chemical irritants
Strong emotional expressions
Drugs ( aspirin, beta blockers)

11. CASE SCENARIO How you will approach this patient?
Ahmed 6 years old come to primary care clinic with his father c/o chronic cough for the last 3 months, mainly at night .
How you will approach this patient?

12. HOW TO DIAGNOSE BRONCHIAL ASTHMA ?
Consultation skill
Relevant History
-Symptom
-history of allergic disease
-Family history
-Environmental history
-Exclusion of other medical condition

13. Diagnosis of B.A ( cont.) Relevant physical examination Investigation
Do you need to do investigation?
Why ?
Follow up
Medical record
Role of Peak Flow Meter

14. CLASSIFY ASTHMA SEVERITY
Mild intermittent Asthma (step1)
Mild persistent Asthma (step2)
Moderate persistent Asthma (step3)
Severe persistent Asthma (step4)

15. How to manage and control Bronchial Asthma
Educate patients to develop a partnership in asthma care
Assess and monitor asthma severity
Avoid exposure to trigger factors
Establish individual medication plans for long term management in children and adults

16. How to manage and control Bronchial Asthma ( cont.)
Establish individual plans to manage asthma attacks
Provide regular follow up care.

17. Stepwise approach ( children)
classification
mild Intermittent
Mild persistent
Moderate persistent
Severe persistent
Minor symptoms
< 1/week
1-3 /week
4-5/week
Continuous
exacerbation/ nocturnal
< 1/month
1 /month
2-3/month
> 4 /month
PEF between attacks
>80%
60-80%
< 60%
Step 1
Step 2
Step 3
Step 4

18. Stepwise approach ( adult)
classification
mild Intermittent
Mild persistent
Moderate persistent
Severe persistent
Minor symptoms
< 2 /week
2-3 /week
4-5 /week
Continuous
exacerbation/ nocturnal
< 2 /month
2-3 /month
4-5 /month
> 5 /month
PEF between attacks
>80%
60-80%
< 60%
Step 1
Step 2
Step 3
Step 4

19. Evidence Based approach
Clinical evidence
Cochrane library

20. Evidence Based approach (example)
Clinical Evidence
۩ What are the effects of treatments for chronic asthma?
۩ what are the effects of treatments for acute asthma?
- Beneficial
- Likely to be Beneficial
- unknown effectiveness

21. INTERNET SITE Guidelines NHLBI/ WHO report http://www.ginasthma.com
Cochrane Site:
Clinical Evidence:

22. QUESTIONS ????

23. THANK YOU WITH MY BEST REGARDS

24. PRACTICAL
GROUP (A)
- Simple clinical algorithm for management of bronchial asthma among ADULT in PHC clinic
GROUP (B)
- Simple clinical algorithm for management of bronchial asthma among CHILDREN in PHC clinic
Group (c)
- Simple clinical algorithm for management of bronchial asthma in EMERGENCY

25. REFERENCES and FURTHER READINGS
The National Scientific Committee of Bronchial Asthma in Saudi Arabia. The National Protocol for the management of Asthma, fourth edition1424/2003.
National Heart, lung, and Blood Institute, National Institute of Health. WHO workshop report. Global Strategy for Asthma Management and Prevention,2002.