Bronchial Asthma

Bronchial Asthma

Types
 Extrinsic Asthma – It Occurs in Atopic individuals – Skin
sensitivity tests

 Intrinsic Asthma – No role of Allergens in producing the disease

 Predisposing Factors :
 Allergens :
 a) Ingested ( Fish ,Nuts ,Straw berries )
b) Inhaled
 c) Food additives : Metabisulphate preservatives
 d) Occupational allergens : Grain –Dust ,
Wood dust )
 Mechanism Involved : Mucus Hypersecretion &
Bronchial Hyperresponsiveness
 Clinical Features :
 Other Conditions for Wheeze are : COPD,
TB, Cardiac Asthma,Tumours & ABPA.
 Nocturnal
 Gastric
 Exercise – induced Asthma
 Episodic
 Status asthmaticus
INVESTIGATIONS
 CXR – To ruleout other causes of Wheeze
& Pneumothorax
 PFT
 PEF
Management
 Treatment of Infection
 Avoidance of Allergens and other
predisposing Factors
 Drugs
 Hyposensitisation
DRUGS
PREVENTION :
• Sodium Chromoglycate – Children – 4
weeks -20 mg ---Spinhaler – for Atopic
• Nedocromil Sodium – Anti inflammatory drug

– 4mg -2/4 times daily – MDI
• Ketotifen : 1-2 mg with food daily : less

effective than above two drugs
 Anticholinergics : Ipratropium bromide by
MDI – Drug Indused Asthma
 Methyl xanthines :
a) Oral theophylline
b) IV Aminophylline : if serum increases
it leads to seizures & arrythmias.
Management of Asthma
 Classification of Severity :
Symptoms Night time Symptoms PEF
Step 1 < 1 time a week < 2 times a month > 80 %
Step 2 > 1 time/ week > 2 times a month > 80 %

Mild persistent but < 1 time a day
Step 3 Daily > 1 time 1 week > 60 & < 80 %

Moderate Persistent
Step 4 Continuous Frequent < 60 %

Severe Limited Physical activity
Drugs to reverse Bronchospasm
 Adrenergic Stimulants :
Catecolamines(epinephrine, isoproterenol)
 Salmeterol , Bambuterol – Long lasting B2

Agonists with long duration of action .
They produce Airway dilatation
Catecholamines – Short acting Epinephrine 0.3 ml

subcutaneously
Treatment
Long term Preventive Quick Relief
 Step 1 None needed >Short acting B2 Agonists

> Inhaled B2 Agonist / Cromoglycate
before exercise / exposure to allergen
Step 2 Daily medications

Mild persistent . Inhaled Cortecosteroid/ . Shortacting Bronchodilator :
sustained release theophylline/ inhaled B2 agonists as needed.
cromoglycate/ nedocromil symptoms 3-4 times/day

. Either inhaled B2 agonists /
long lating B2 agonists tablets
can be added
Long term Preventive Quick relief
 Step 3 Daily Medication . short acting B-Dilator:

Moderate persistent . Inhaled Cortecosteroid and if needed . inhaled B2 agonist
. Long lasting bronchodilator: against symptoms not
. Long acting inhaled B2 agonist/ to exceed 3-4 / day
Tablets / sustained theophylline
. Step 4 Daily medication :

. severe persistent . Inhaled cortecosteroid / more . Short acting Bronchodilator
Long lasting Bronchodilator inhaled B2 agonists
Cortecosteroid tablets
Indications for Assisted Ventillation
 Coma
 Respiratory Arrest
 Exhaustion,confusion ,Drowsiness
Physiotherapy
1) To relieve Bronchospasm
a) Positioning
b) Nebulisation
c) IPPB
2) To assist in Removal of secretions

a) HME
b) Breathing Exercises
c) Humidification
d) PD
e) Manual Techniques
f) ACBT
g) AD
h) Mechanical Aids
. PEP
. Mechanical Percussors ,Vibrators & Oscillators
. Flutter
. IPPB
i) Cough facilitation
j) N P Suction
k) Mini Tracheostomy
3) Methods to decrease Work of Breathing :
. Sleep
. Stress Reduction
. Yoga
. Relaxation Positions
. Breathing Reducation
. Abdominal Breathing
. Mechanical Aids
IPPB, CPAP & NIPPV
4) To improve Exercise Tolerance
. Mechanism of Training
. Safety
. Method
. Exercise Prescription – I , D ,F & Progression
5) To Improve Lung Volume
6) To improve Strength and Endurance of

Inspiratory Muscles & Inspiratory Muscle
Training
7) Energy Conservation
8) Gain Relaxation & Mobility of the Neck ,

Shoulder Girdle & Upper Chest Muscles
9) Postural Awareness
10) Pt Education & Home Programme

THANK YOU

Bronchial Asthma

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Bronchial Asthma

 Intrinsic Asthma – No role of Allergens in producing the disease

• Nedocromil Sodium – Anti inflammatory drug

• Ketotifen : 1-2 mg with food daily : less

Step 2 > 1 time/ week > 2 times a month > 80 %

Step 3 Daily > 1 time 1 week > 60 & < 80 %

Step 4 Continuous Frequent < 60 %

 Salmeterol , Bambuterol – Long lasting B2

Catecholamines – Short acting Epinephrine 0.3 ml

 Step 1 None needed >Short acting B2 Agonists

before exercise / exposure to allergen

Step 2 Daily medications

cromoglycate/ nedocromil symptoms 3-4 times/day

 Step 3 Daily Medication . short acting B-Dilator:

. Step 4 Daily medication :

2) To assist in Removal of secretions

6) To improve Strength and Endurance of

8) Gain Relaxation & Mobility of the Neck ,

10) Pt Education & Home Programme

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