Asthma attack(status asthmaticus) Groups
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This document provides an overview of asthma, including: 1) Asthma is a chronic inflammatory disease of the airways characterized by recurrent wheezing, chest tightness, coughing, and shortness of breath. 2) Risk factors include genetic and environmental factors such as exposure to allergens, tobacco smoke, and viral infections. 3) Diagnosis is based on a patient's respiratory symptoms and improvement following bronchodilator treatment; spirometry can also be used.
Asthma attack(status asthmaticus) Groups
- 1. Asthma By : Bushra Abdulrahman Mzhda Salman Shno Sabah Parez Younis Supervisor : Dr. Kawez Zangana
- 2. Objectives • What is Asthma • Epidemiology • Risk Factor • Diagnosis • Acute Severe Asthma • Long term asthma management • Advice and preventive measures • prognosis
- 3. What is Asthma • Asthma is a chronic inflammatory disease of the airways. Recurrent Reactive Reversible
- 4. Asthma shortness of breath Coughing 90 % chest tightness wheezing 74 %
- 5. Pathophysiology Exposure to allergens & irritants IGE stimulation & Mast cells degradation Bronchospasm,mucus secretion & edema of the wall Prostaglandins [Lukotrienes Histamine
- 7. Epidemiology . 30% of children wheeze by age 3 yrs . only one third of these children have persistent symptoms up to age. . M to F ratio is 1.8:1 in childhood . At puberty ratio is equal
- 8. When Does Asthma Begin .By 1 year - 26% .1 -5 year - 51% .> 5 year - 22 % 77% of asthma begins in children less than 5 years. It’s recurrent, there is complete cure between episodes. But usually confirming the Diagnosis is after 5 years of age.
- 9. Risk factor 1) Genetic factors 2) Environmental factors ; mostly viral ,Exposure to tobacco smoke. Animals , chemicals ,dusts, gases. 3) Atopic diseases ; eczema , allergic rhinitis. 4) Maternal status ; both physical and mental like anaemia & depression are associated with asthmatic stress for the child. 5) Early antibiotic use ; 50% more likely to develop asthma .
- 11. a characteristic pattern of episodic respiratory symptoms and signs in the absence of an alternative explanation Diagnosis of Asthma is Purely Clinical Diagnosis
- 12. Respiratory symptoms predominant nonproductive cough Wheeze Difficulty of Breathing or Shortness of breath after exercise Chest Pain
- 13. Personal History of Atopic disorder Family History of Asthma or Atopic Disorder History of Improvement of symptoms or lung function after using bronchodilators
- 14. Classification of Asthma Mild Symptoms > 2 times a week but < 1 time a day Night Symptoms > 2 times a month Moderate PEFR 50-80% Predicted ,persistent cough, loud wheeze With Daily use of inhaled short-acting 2- agonist Exacerbations ≥ 2 times a week; may last days Acute Severe PEF< 30-50% predicted , Inability to complete sentence in 1 breath, Signs of Respiratory Distress . ↑RR , ↑ HR . Normal PaCo2 Life Threatening PEF< 33% predicted , SpO2 < 92% or PaO2 < 8kPa (60mmHg) . Silent chest, ↓ HR , ↓ BP , Confusion , Coma , Near Fatal High PaCo2 or requires Mechanical ventilation
- 15. Severe Asthma Attack Respiratory distress
- 16. Chest Exam Inspection : Barrel-shaped chest, decreased movement and Intercostal retractions Palpation : Increased tactile fremits Percussion: Hyper resonance chest. Auscultation : Decreased air entry, Wheeze and prolonged expiration, decreased vocal resonance
- 17. Investigations Spirometry Spirometer ,Procedure , Limitations of test age > 6 year CXR We will do PA or Lateral View, it will show hyper inflated chest Pulse oximetry for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation
- 18. Parameters of Spirometry • Peak expiratory flow rate (PEFR) <80% predicted for height. • FEV1/FVC <80% predicted. • Concave scooped shape in flow volume curve. • Bronchodilator response to β-agonist therapy (i.e. 15% increase in FEV1 or PEFR).
- 23. Management of asthma exacerbations: • Initial assessment: • Supportive treatment: Supplemental O2(humidified), IV Fluid, Antibiotics.. • Nebulized SABA: e.g. salbutamol (ventolin). • Oral systematic or IV Corticosteroids. • Anti cholinergic: Ipratropium bromide. • IV MgSO4. • epinephrine IM or turbutaline Sc. • Intubation & Mechanical ventilation with 100% oxygen.
- 24. Complications of acute severe asthma: Aspiration pneumonia Pneumothorax Massive lung collapse Pneumomediastinum and surgical emphysema Acute Respiratory failure and Respiratory arrest Cardiac arrest
- 25. Long term asthma management The long-term goals of asthma management : • to achieve good symptom control • to minimize future risk of exacerbations • fixed airflow limitation and side-effects of treatment.
- 26. The control-based asthma management cycle
- 27. ASTHMA MEDICATIONS Controller medications Reliever (rescue) medications Add-on therapies for patients with severe asthma
- 28. Classify a Child as Chronic Asthma • Infrequent episodic asthma (<4 episode per yr) (SABA) • Frequent episodic (every 2-4wk) (relieve by SABA with use regular low ICS) • Persistent asthma(> or = 3 episodes with cough at night/early morning) (ICS,LABA,Oral steroid, leukotriene inhibitors) • Exercise induced asthma (use SABA before exercise)(if severe ICS)
- 32. Advice and preventive measure • Self-monitoring of symptoms and/or peak flow • Physical activity • Avoidance of occupational exposures • Avoidance of medications that may make asthma worse • Healthy diet • Avoidance of indoor allergens • Weight reduction • Allergen immunotherapy • Breathing exercises • Avoidance of indoor air pollution • Vaccinations • Bronchial thermoplasty • Avoidance of outdoor allergens
- 33. Prognosis • Occur in 35% of pre-school children 1/3 continue to have persistent asthma , 2/3 will improve • Children with mild + normal lung function are likely to improve over time • Children with moderate to severe asthma +lower lung function measures are likely to have persistent asthma • Complete remission uncommonly occur