1. Bronchial Asthma Flashcards
What is the definition of Bronchial Asthma?
Bronchial Asthma is a heterogeneous, variable, reversible disease with expiratory airflow limitations and chronic airway inflammation
What are the criteria required in the Triad of Bronchial Asthma?
- Chronic Airway Inflammation
- Airway hyper responsiveness
- Recurrent and Variable episodes
What is the aetiology for Bronchial Asthma?
GED A VOICE
- Genetic Factors
- Environmental Exposure to Allergens (Grass pollen and domestic pets)
- Oral and Topical Drugs (NSAIDS, Beta-adrenoreceptor blocking agents)
- Atmospheric Pollution (Sulphur dioxide, Ozone, Particulate matter)
- Viral Infections (Rhinovirus, Parainfluenza virus, RSV)
- Occupational Sensitizers
- Irritant dusts, Vapour & Fumes (Perfume and Cig. Smoke)
- Cold Air
- Emotion
What are the 4 characteristics of an airway in Asthma?
- Narrowed lumen
- Increased volume and viscosity of mucous
- Muscle spasm and hypertrophy
- Mucosal oedema and Inflammation w. Cellular Infiltrate
What are the clinical features of Bronchial Asthma?
- Wheezing
- Shortness of breath
- Predominant cough
*Attacks are worst at night and varies greatly in freq., intensity and duration
What are the differential diagnosis for Bronchial Asthma symptoms?
- COPD
- Asthma-COPD overlap (ACO)
- Cardiac Failure (LVF)
- Acute Bronchitis
- Bronchiolitis
A patient is suspected to have Bronchial Asthma, what are the 3 Lung Function Tests you’d like to test on the patient?
- Peak Expiratory Flow Rate
- Spirometry
(Asthma diagnosed when >15% improvement seen in FEV1/PEFR following inhalation of bronchodilator) - CO transfer test is normal
Name 4 other tests carried out to confirm Bronchial Asthma besides Lung Function Tests and the reason behind carrying them out.
- Exercise Test (6 minute walk/run test)
- Exhaled Nitric Oxide (To measure airway inflammation)
- Chest X-Ray (To exclude complications)
- Skin Allergy Test (To identify the allergen)
How do you classify patients with Bronchial Asthma?
- MILD INTERMITTENT :
- Symptoms = <2 days per week
- Nighttime Time Awakenings = <2 days per month
- Interference w. Daily Life = None
- Lung Function = FEV1 > 80% of predicted amount - MILD PERSISTENT :
- Symptoms = >2 days per week, but not daily
- Nighttime Time Awakenings = 3-4 days per month
- Interference w. Daily Life = Minor limitation
- Lung Function = FEV1 > 80% of predicted amount - MODERATE PERSISTENT :
- Symptoms = Daily
- Nighttime Time Awakenings = >1 per week, but not daily
- Interference w. Daily Life = Some limitation
- Lung Function = FEV1 is 60% - 80% of predicted amount - SEVERE PERSISTENT :
- Symptoms = Throughout the day
- Nighttime Time Awakenings = Almost daily
- Interference w. Daily Life = Extreme limitation
- Lung Function = FEV1 < 60% of predicted amount
What are the goals of treatment in a patient with Bronchial Asthma and how do you plan to achieve them?
- REDUCE IMPAIRMENT :
- By freeing the patient from the symptoms by administration of medication
- By optimization of lung functions
- By enabling the patient to carry out daily activities - REDUCE RISK :
- By preventing risk of recurrence and need of hospital admissions
- By preventing loss of lung functions
- By optimizing patient’s medication to minimize/avoid occurence adverse effects
How do you manage a case of Bronchial Asthma?
- Conduct routine monitoring of symptoms and lung functions of the patient
- Control triggering factors (allergens) and co-morbid conditions that contribute to asthma severity
- Providing pharmalogic therapy to the patient
- Providing education to the patient and family
Name 4 types of drugs used in pharmacologic therapy of Bronchial Asthma patients.
- SHORT ACTING BETA AGONISTS (SABA)
- Salbutamol, Levosalbutamol, Terbutaline - LONG ACTING BETA AGONISTS (LABA)
- Salmeterol, Formoterol - INHALED CORTICOSTEROIDS (ICS)
- Beclomethasone, Budesonide, Fluticasone - INHALED ANTIMUSCARINIC
- Ipratropium, Tiotropium
- Short Term Reliever : SABA
- Long Term Reliever and Controller : LABA, ICS, Leukotriene modifiers
- Other bronchodilators : Inhaled antimuscarinics, Theophyllines, oral steroids
- Steroid-sparing agents : Methotrexate, Omalizumab, Etanercept, Infliximab
Besides Pharmacologic Therapy, name another therapy which is effective in treating Bronchial Asthma, it’s function and it’s benefits.
INHALED THERAPY
- Function : Drugs are delivered as aerosols/powders directly to the airways
- Benefits : 1st Pass Metabolism in the Liver and unwanted systemic effects are avoided
Name 4 delivery systems used in the treatment of Bronchial Asthma.
- Metered Dose Inhalers
- Dry Powder Inhalers
- Spacers/Holding Chambers
- Nebulizers
Explain the ‘Step-Wise Treatment’ used to determine the treatment regime for Bronchial Asthma patients.
STEP-WISE TREATMENT :
- MILD INTERMITTENT : As-needed ICS (Low dose)
- MILD PERSISTENT : Daily ICS (Low dose)
- MODERATE PERSISTENT : ICS (Low dose) and LABA
- SEVERE PERSISTENT (1) : ICS (High dose), LABA and Theophylline, Montelukast, Oral Beta Agonist Anticholinergic drugs
- SEVERE PERSISTENT (2) : ICS (High dose), LABA, Oral Corticosteroids and Anti-IgE agents (Omalizumab), Immunosuppressants
