Asthma

A talk by Joe and Marv

Normal Function of Lungs

Lungs are a series of tubules, ending in sacks (alveoli) Tubes need to remain patent to allow air through

What happens in asthma?

Definition: Chronic inflammatory disease of the airway characterised by airway obstruction inducing recurrent episodes of dyspnoea, wheeze and cough.

Classified Extrinsic asthma (External cause) or intrinsic asthma (no causative agent identified) Extrinsic asthma occurs more frequently in atopic individuals, show +ve skin prick test to inhalant allergens (pollen) Intrinsic asthma normally starts in middle age with childhood symptoms of asthma.

Pathogensis

Aetiology TRIAD contribute to airway narrowing 1. Bronchial muscle contraction (triggered by a range of stimuli) 2. mucosal inflammation (mast + basophil degranulation) 3. Increased mucus production.

Affects mainly the Bronchi and Bronchioles Immune mediated Symptoms are caused by inflammation and bronchospasm

Symptoms

Coughing Shortness of breath Wheezing Chest tightness Needing to use accessory muscles Often worse at night or at other times when its cold Linked to other causative factors that can trigger worsening of symptoms and/or an exacerbation

Triggers

Exercise (catecholamine effects) Airborne chemicals/irritants (such as smoke) Cold air Extremes of emotion Periods Idiopathic

Aetiology

Linked to several factors such as smoking in parents, including maternal smoking during pregnancy, poor quality air (some cities etc). Exposure to certain organic chemicals Genetic component Clean world Hypothesis

Acute Asthma Exacerbation (Asthma Attack)

Acute worsening of symptoms during an acute episode. Often brought on following exposure to a trigger Severe cases may require hospitalisation Can often be managed through the use of a reliever inhaler (treatments discussed later)

British Thoracic Society Guidelines

Diagnosis of asthma is made based on reversibility of symptoms

Spirometrey results showing an obstructive pattern (Reduced FEV1 /FVC)

Peak Flow readings, 3 readings showing 20% variability or greater In both cases

Stepwise Treatment Plan

Stepwise Treatment

First Line is a Salbutamol Inhaler (the blue ones- also called a reliever)- normally used during exacerbations for relief

If symptoms worsen, a second inhaler can be added. This would be a brown steroid inhaler, or preventer
If it gets worse still, a long acting beta-2 agonist can be added- this is often combined with the steroid in the the inhaler (normally a pink or egg one) If symptoms are still not adequately controlled, the dose of steroids in the inhaler can be increased. Oral steroid are the final step of treatment, but it is not desirable to be giving these to kids.

Administering the treatment

Kiddies (especially babies) may have difficulty timing breathing in order to uses

In may be beneficial to use a spacer or even a nebuliser

Contraindications in Asthma

Avoid administering Beta Blockers or NSAIDS to asthmatics May trigger exacerbation/worsening of symptoms