Bronchial Asthma

Bronchial Astma
Chest Department
Ain Shams University
Burden of Asthma
 Asthma is one of the most common chronic
diseases worldwide with an estimated 300 million
affected individuals
 Prevalence increasing in many countries,
especially in children
 A major cause of school/ work absence
Definition of Asthma
 A chronic inflammatory disorder of the airways
 Many cells and cellular elements play a role
 Chronic inflammation is associated with airway hyper-
responsiveness that leads to recurrent episodes of
wheezing, breathlessness, chest tightness, and coughing
 Widespread, Variable, and often reversible airflow
limitation
Asthma Inflammation: Cells and Mediators
Risk factors for development of asthma
 Genetic characteristics
 Environmental exposures
 Contributing factors
Risk factors for development of Asthma:
Genetic characteristics
Atopy
 The body’s predisposition to develop an antibody

called immunoglobulin E (IgE) in response to
exposure to environmental allergens
Risk factor development of Asthma:
Environmental exposures
Diagnosis should be based on:
 Symptoms
 Past medical history
 Family history
 Physical examination
 Investigations
1- Symptoms:
It is sometimes possible to make an almost
certain diagnosis from asking the patient about
their current symptoms
 Cough
 Wheeze
 Breathlessness
 Tightness across the chest
1- Symptoms:
History of Symptoms are therefore very
important:
 What the symptoms are
 When the symptoms first started
 What causes the symptoms to occur (i.e. trigger factors)
 How often the symptoms occur during the day or at night
 How long the symptoms last
 What relieves the symptoms
Differential diagnosis
Correct diagnosis of asthma is made more difficult
because there are other respiratory conditions that have
similar symptoms
 Acute bronchitis
 Bronchiectasis
 Cystic fibrosis
 Chronic obstructive pulmonary disease (COPD)
 Cardiac asthma (Pulmonary Edema)
 Bronchiolitis
 Croup
 F B aspiration
II- Past Medical History
Many patients with asthma, Particularly
children, have a history of recurrent upper and
lower respiratory- tract infections, allergy, such
as eczema and hay fever
 Sinusitis
 GERD
 Co-morbidity:
 HTN: B-blockers, ACE.
 DM
III- Family History
 Family members (a parent or sibling) have a
history of allergy or asthma.
 Children of mothers who smoked whilst

pregnant, or children living in families where
they are exposed to passive smoking, are more
likely to develop asthma
IV- Physical Examination
 Stethoscope may enable the clinician to identify wheeze,
indicating obstructed airflow
 Physical examination may not detect any abnormalities,

but can exclude other possible causes, such as chest
infection or heart failure.
 In children, it is important to record height and weight,

because it is recognized that uncontrolled asthma can
affect growth.
V- Investigations
Once a comprehensive history has been taken, and the
patient examined, lung function tests should be carried
out to confirm the diagnosis
 Serial peak flow monitoring

 Spirometry lung function
 Reversibility tests
 Provocation test
Tests for diagnosis and monitoring
Spirometry
 Measures the volume and speed of air inhaled and exhaled, calculating the
forced expiratory volume in one second (FEV) and forced vital capacity
(FVC)
The meth choline test
 Patient inhale nebulized meth choline to induce bronchoconstriction
before and after spirometry testing to assess the degree of airway
marrowing.
 Asthmatic patients will react to lower doses of meth choline due to pre-
existing airway hyper-reactivity
Peak expiratory flow (PEF)
 The maximum speed of expiration
 It measures a patient’s ability to exhale and identifies any obstruction of
air flow through the bronchi
The use of Spirometry
 Spirometry can be used to establish a diagnosis of
asthma by measuring airflow limitation and its
reversibility.
 An increase in FEV, of ≥12% and bronchodilator
indicates reversible airflow limitation consistent
with asthma.
 Many lung diseases may result in reduced FEV, so
the ratio of FEV, to FVC is a useful assessment of
airflow limitation.
 A normal FEV, FVC ratio is >70 any lower value
may suggest airflow limitation, which may be due
to asthma or COPD.
Peak Expiratory flow
 Peak expiratory flow (PEF) is the maximum rate of air forcibly

exhaled starting from full inspiration.
 It is measured in liters per minute (L/min)
 Peak expiratory flow is a simple, quick and inexpensive lung-
function test and is often the only one used in general practice.
Serial peak flow monitoring
Serial peak flow monitoring

Reversibility testing
 The patient’s PEF is measured and
recorded
 The patient is given a short-acting B2

agonist bronchodilator (a drug that
stimulates B2 receptors to relax the
smooth muscles in the airways) and
asked to wait for 15-20) minutes.
 The PEF is recorded again a difference of

15% or more between the first and
second reading is diagnostic of asthma.
Reversibility Testing
 The aim of reversibility testing is to establish
whether an obstructed airway with reduced flow can
be significantly dilated, i.e. the obstruction reversed.
Asthma Management
 Long term management
 Exacerbations
Goals of long-term management
 Achieve and maintain control of symptoms
 Maintain normal activity levels, including exercise
 Maintain pulmonary function as close to normal
 Levels as possible
 Prevent asthma exacerbations
 Avoid adverse effects from asthma medications
 Prevent asthma mortality
Total control
Levels of asthma control
 Characteristic
 Daytime symptoms
 Limitations of activities
 Nocturnal symptoms/ awakening
 Need for rescue/ reliever treatment
 Lung function (PEF or FEV1)
 Exacerbation
Controlled (all of Partly controlled (Any
Characteristic Uncontrolled
the following) present in any week)
Daytime None (2 or less/
More than twice/ week
symptoms week)
Limitations of
None Any
activities 3 or more
(features of
Nocturnal
partly
symptom/ None Any
controlled
awakening
asthma
Need of rescue/ None (2 or less/ present in
More than twice/ week
reliever treatment week) any week
<80% predicted or
Lung function
Normal personal best (if known)
(PEF or FEV1)
on any day
Exacerbation None One or more / year 1 in any week
The four major components of asthma management
The four inter-related key components of asthma management:
Identify and
Develop a Assess, treat Manage
reduce
patient/doctor and monitor asthenia
exposure to
partnership asthma exacerbations
risk factors

Bronchial Asthma

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Bronchial Astma

 The body’s predisposition to develop an antibody

 Children of mothers who smoked whilst

 Physical examination may not detect any abnormalities,

 In children, it is important to record height and weight,

 Serial peak flow monitoring

 Peak expiratory flow (PEF) is the maximum rate of air forcibly

Serial peak flow monitoring

 The patient is given a short-acting B2

 The PEF is recorded again a difference of

 Long term management

The four inter-related key components of asthma management:

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