ASTHMA CPC 26 FEB.pptxDetailed description on asthma
2. ASTHMA IN PREGNANCY
RESIDENT : Dr Ramsha Tariq
CONSULTANT : Surg Lt Cdr. DR KAMRAN DAR
HOUSE OFFICERS :
DR. AREESH ,
DR. HIFZA
DR. ADNAN
4. Presenting Complaint:
28 year old married female G2p0+1(GA =24 wks), k/c of allergic
rhinitis, nursing student, resident of Baldia town came to the ER
with:
- Fever ¬ 3 days
- Cough ¬3 days
- SOB ¬ 1 day
CASE PRESENTATION:
5. History of Presenting Complaint :
:
My patient was in her usual state of health until 3 days ago when she
developed fever which was intermittent in nature, documented(101 F) not
associated with rigors and chills for which she took Paracetamol after
which the fever resolved.
Patient had productive cough which was associated with sputum which was
yellowish green in colour for which she took syrup acefyl which didn’t give
any relief. She also experienced headache, generalized body ache, leg pain
and fatigue 3 days ago.
She developed SOB in the evening 1 day back and was nebulized 3 times
with atem and clenil after which her SOB relieved for 5 hours after which
she presented to ER in night on 27 Jan 25, then shifted from ER to ICU.
6. Past medical history: Hx of spontaneous miscarriage in march 2024
Past surgical History : Insignificant.
Family History: Insignificant.
Personal History: Patient experienced sleep disturbance due to cough at night. Appetite
decreased, bowel habits and micturition habits are normal.
Allergic History: Allergic rhinitis
Transfusion History: Nil.
Drug History : Betenesol for allergy
Social History: Socioeconomic status is satisfactory ,belongs to a middle class family ,
lives in a well ventilated house, uses filtered water.
7. Systemic review :
CNS : No Headache , No Fits etc.
CVS :, No chest pain , No edema etc.
Abdomen : Lower abdominal pain, No vomiting.
Locomotory : No pain or weakness.
8. ON General Physical Examination while in ICU:
Patient appears oriented and irritable, with tachypnea
However there were no signs of Jaundice, Cyanosis,
Lymphadenopathy, Anemia or Edema
• Vital signs:
• Pulse: 115 bpm
• Respiratory rate: 30 bpm
• Blood pressure: 115/67 mmHg
• Oxygen saturation: 96% on 10Litres O2 via rebreather mask
9. • Chest Examination:
• Inspection:
• Use of accessory muscles noted during breathing.
• No visible cyanosis.
• Palpation:
• Symmetrical chest expansion.
• No palpable masses or tenderness.
• Percussion:
• Resonant percussion notes bilaterally.
• Auscultation:
• Bilateral wheezing heard predominantly in the expiratory phase
• CNS , CVS and rest of examinations are unremarkable.
15. Patient’s Outcome
■ Patient’s Condition was improved and she was shifted from
Ward 10( ICU) to Ward 11 where she was maintaining
Oxygen Saturation at 97% on Room Air and then she was
discharged.
16. ASTHMA
Asthma is a heterogeneous disease, usually
characterized by chronic airway inflammation. It is
defined by the history of respiratory symptoms, such as
wheeze, shortness of breath, chest tightness and
cough, that vary over time and in intensity, together
with variable expiratory airflow limitation.
17. CLINICAL PHENOTYPES OF ASTHMA:
Many clinical phenotypes of asthma have been identified. Some of the most common
are:
Allergic Asthma
Non-allergic Asthma
Adult-onset (late-onset) Asthma
Asthma with persistent airflow limitation
19. CLINICAL MANIFESTATION :
The following features are typical of asthma and, if present,
increase the probability that the patient has asthma:
Wheeze
Shortness of breath
Cough
Chest tightness
20. INCIDENCE
Leading chronic issue in children and young adults
Increase both in develop and developing countries.
4.3 % Pakistan’s population suffer from asthma.
Adults 5 to 10%
Children's 19%
Increased by 61% from last 2 decades world wide.
Source : The Global Asthma Report 2022
21. INVESTIGATION
History and Examination
Pulmonary function testing
Peak expiratory flow (PEF)
Blood/Sputum studies
Chest X-ray
IGE levels /skin allergen testing
Methacholine Challenge Test
22. PULMONARY FUNCTION TEST
Pulmonary function testing with either “spirometry” or
“peak expiratory flow measurements” are important
for the diagnosis and management of patients with
asthma.
Important spirometry measurements include forced
expiratory volume in 1 second (FEV1 ), forced vital
capacity (FVC), and FEV1 /FVC before and after the
administration of a short-acting bronchodilator.
Significant reversibility of airflow obstruction by an
increase of 12% or more in FEV1 or FVC after
inhaling a short-acting bronchodilator.
A positive bronchodilator response supports the
diagnosis of asthma
24. GOALS OF ASTHMA MANAGEMENT
Achieve symptom control
Minimize risk of exacerbation
Minimize side effects of treatment
NOTE:
Asthma treatment is best in a multidisciplinary approach using
pharmacologic and nonpharmacologic strategies
25. TREATMENT OF ASTHMA IN
PREGNANCY
■ Inhaled bronchodilators and corticosteroids are first-line maintenance
therapy for asthma in pregnant women. Budesonide is the preferred inhaled
corticosteroid.
■ For an acute exacerbation, in addition to bronchodilators, methyl
prednisolone 60 mg IV every 6 hours for 24 to 48 hours may be used,
followed by oral prednisone in a tapering dose.
■ According to GINA(2024) , Asthma should be monitored every 4-6 weeks.
Ensure all patients are on ICS to avoid complications with acute
exacerbations. ICS shouldn't be stopped and exacerbations to be treated
aggresively
31. DETAILED COUNSELLING OF PATIENT
SHOULD BE DONE REGARDING:
Understand your condition
Identify and avoid triggers
Use inhalers correctly
Monitor your symptoms
Purpose of long and short term
medication
Side effects of medication
33. LETS REMOVE THE
STIGMA OF ASTHMA
A BARRIER TO USING INHALERS IN PUBLIC
"It's understandable that some people may
feel hesitant or even a bit wary about using
inhalers, but we should counsel and assure
them that they are not taboo at all. In fact,
inhalers are one of the most effective tools
we have for managing asthma and other
respiratory conditions.
37. OBJECTIVE
To examine the relationship between asthmatic
pregnancies and selected maternal and neonatal
outcomes in a representative cohort
38. METHODS
■ A retrospective cohort study was conducted at the Aga Khan
University Hospital.
■ A random selection was made of 65 asthmatic and 63 non-
asthmatic singleton births.
■ The neonatal outcomes studied were birth weight, premature
birth and Apgar scores at 1 and 5 minutes.
39. ■ The maternal outcomes studied were number of hospital
admissions, and number of documented UTI during the studied
pregnancy and past history of abortions and stillbirths.
40. RESULTS
■ Neonates born to asthmatic mothers had shorter
mean gestational age with increased risk of premature birth
and lower Apgar scores.
■ Asthmatic mothers had a greater risk of abortions and low birth
weight babies.
■ They also had higher rates of UTI's and hospital admissions.
41. CONCLUSION
■ Asthmatic pregnancies are more likely to result in abortion,
premature delivery and low birth weight babies.
■ The asthmatic pregnancies were also linked with higher rates
of maternal UTI.
■ Therefore a more vigilant monitoring is required in asthmatic
pregnancies.
43. OBJECTIVE
Objective was to identify the factors that affect asthma
control in pregnant Pakistani women presenting to a
tertiary care hospital.
44. METHODS
■ This descriptive, cross-sectional research was conducted at
KRL General Hospital between 1st November 2022 to 30th
April 2023.
■ Non-probability technique was used to sample one hundred
and forty-five pregnant women with confirmed bronchial
asthma irrespective of their trimester presented.
■ Data regarding demographics and factors affecting asthma
control was collected.
45. RESULTS
■ Approximately 48% of participants were non-compliant
with treatment, and less than 40% achieved adequate
asthma control.
■ A chi-squared test applied showed that multiparity (p =
0.003), treatment compliance (p < 0.001), BMI (p <
0.001), and proper inhaler technique (p < 0.001) were
statistically significant factors affecting asthma control
in pregnant women while,
■ level of education and household income did not exhibit
a significant association.
46. CONCLUSION
■ Ensuring asthma control during pregnancy is important.
■ This study identified BMI, multiparity,
inhaler technique, and treatment compliance as factors
that affect asthma control in pregnant women.
■ Addressing these factors through regular antenatal
check-ups can significantly mitigate risks and promote
the optimal health of both maternal and fetal lives.
