Bronchial Asthma

Question 1

Definition, classification

Answer 1

Definition
It is a chronic reversible allergic reaction characterized by mucus plague ,expiratory dyspnea ,bronchial spasm ,chronic cough
CLASSIFICATION
-Mild intermittent
Symptoms less than two times a week
Nocturnal symptoms less than 2times a month
Lung function FEV is greater than or equal to 80%
-Mild persistent
Symptoms >2 times a week but less than one per day
Nocturnal symptoms >2times per month
Lung function FEV is greater than or equal to 80%
-Moderate persistent
Symptoms daily
Nocturnal symptoms once a week
Lung function FEV 60-80%
-Severe persistent
Continual symptoms
Nocturnal symptoms : frequent
FEV less than 60%

Question 2

Symptoms,diagnosis and treatment

Answer 2

DIAGNOSTIC CRITERIA FOR BRONCHIAL ASTHMA:
1. Wheezing high-pitched whistling sounds when breathing out — especially in children (a normal chest examination does not
2. History of Cough, worse particularly at night Recurrent wheeze,Recurrent difficult breathing, Recurrent chest tightness, Symptoms occur or worsen at night, awakening the patient.
Symptoms occur or worsen in a seasonal pattern.

3. family history of asthma or atopic diseases. 
4. Symptoms which occur or worsen in the presence of:

Animals with fur , Aerosol chemicals, Changes in temperature, dust, Drugs such as aspirin and beta blockers, Exercise ,Pollen, Respiratory (viral) infections, Smoke ,Strong emotional expression
INVESTIGATION FINDINGS
1. Objectively; tachypnea with prolonged expiration, wheezing, dry rales

2. Sputum analysis: eosinophils, Kurshman spirals (mucus of small bronchi), Charcot-leiden crystals ( enzymes of eosinophils)
3. General blood analysis: mild leukocytosis, eosinophilia
4. Spirometry: decreased FVC, FEV1, FEV1/FVC, increased daily variability.
   Post-bronchodilator FEV-1 > 15% increase.
   
   5. Positive allergic skin prick test

Treatment 
Relievers 
Short acting bronchodilators (albuterol,ventolin)
B2 agonists 
Salbutamol,ipatropium 

Controllers 
Inhaled steroids (budesonide 
Leukotriene modifiers (singulair ,zafir lukast,theophylline )