logging in or signing up Bronchial Asthma (د/ أشرف الأباصيري ) ashrafalabasiry Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 6107 Category: Education License: All Rights Reserved Like it (11) Dislike it (0) Added: September 22, 2008 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: abearahmed2012 (1 month(s) ago) very very excellent presentation ,please can I have it. Saving..... Post Reply Close Saving..... Edit Comment Close By: ahmad2145 (11 month(s) ago) Very nice and excelent presentation can I take it to benefet from it Saving..... Post Reply Close Saving..... Edit Comment Close By: hossam7500 (12 month(s) ago) thnks. can i have it? Saving..... Post Reply Close Saving..... Edit Comment Close By: delan_iraq (12 month(s) ago) nice it is very good presenation can i have it Saving..... Post Reply Close Saving..... Edit Comment Close By: matkurt (16 month(s) ago) thnks. can i have it? Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Slide 1: SUMMARY By Dr.Ashraf Al-Abasiry,MBBCh,MSc Internist,Primary Care Department Saad Specialist Hospital Email: ashrafalabasiry@yahoo.com Definition : Definition ◘ Asthma is a chronic inflammatory disorder of the airways It is associated with airway hyperresponsiveness that leads to recurrent episodes of: wheezing,breathlessness, chest tightness and coughing, particularly at night or in the early morning. Dr.Ashraf Al-Abasiry Factors Influencing the Development and Expression of asthma : Factors Influencing the Development and Expression of asthma HOST FACTORS Genetic, e.g., Genes pre-disposing to atopy Genes pre-disposing to airway hyperresponsiveness. Obesity Sex Dr.Ashraf Al-Abasiry Slide 4: ENVIRONMENTAL FACTORS • Allergens Indoor: Domestic mites, furred animals (dogs, cats, mice), cockroach allergen, fungi, molds, yeasts Outdoor: Pollens, fungi, molds, yeasts Infections (predominantly viral) Occupational sensitizers • Tobacco smoke. Passive smoking/Active smoking. • Outdoor/Indoor Air Pollution. • Diet. Dr.Ashraf Al-Abasiry Slide 5: Dr.Ashraf Al-Abasiry MECHANISMS OF ASTHMA : MECHANISMS OF ASTHMA ◘ Asthma is an inflammatory disorder of the airways, which involves several inflammatory cells and multiple mediators that result in characteristic pathophysiological changes. ◘ This pattern of inflammation is strongly associated with airway hyper- responsiveness and asthma symptoms. Slide 7: Environmental risk factors (causes) INFLAMMATION Airway Airflow hyperresponsiveness limitation Precipitants Adapted with permission from Stephen T. Holgate, M.D., D.Sc. Symptoms Asthma is a chronic inflammatory disorder of the airways. Slide 8: Dr.Ashraf Al-Abasiry Clinical Diagnosis : Clinical Diagnosis Medical History Symptoms: Episodic breathlessness, wheezing, cough, and chest tightness. Episodic symptoms occur after an incidental allergen exposure. Seasonal variability of symptoms and a positive family history of asthma and atopic disease are also helpful diagnostic guides. Dr.Ashraf Al-Abasiry Physical Examination : Physical Examination Signs of an asthmatic attack are: wheezing, tachypnea, prolonged expiration, tachycardia, rhonchous lung sounds ,and over-inflation of the chest. During a serious asthma attack, the accessory muscles of respiration may be used, and the presence of a paradoxical (a pulse that is weaker during inhalation and stronger during exhalation). Tests for Diagnosis and Monitoring : Tests for Diagnosis and Monitoring 1- Measurements of lung function. Measurements of lung function, and particularly the demonstration of reversibility of lung function abnormalities, greatly enhance diagnostic confidence. Two methods have gained widespread acceptance for use in patients over 5 years of age. These are spirometry, and peak expiratory flow (PEF) measurement Dr.Ashraf Al-Abasiry Slide 12: Spirometry : is the recommended method of measuring airflow limitation and reversibility to establish a diagnosis of asthma to demonstrate reversibility FEV1 < 80% predicted; FEV1/FVC <65% or below the lower limit of normal FEV1 increases >12% and at least 200 mL after using a short-acting inhaled beta2-agonist Dr.Ashraf Al-Abasiry Slide 13: Peak expiratory flow measurements are made using a peak flow meter and can be an important aid in both diagnosis and monitoring of asthma. measurements should preferably be compared to the patient’s own previous best measurements using his/her own peak flow meter. Dr.Ashraf Al-Abasiry Slide 15: 2- Measurement of airway responsiveness. 3- Non-invasive markers of airway inflammation. 4- Measurements of allergic status. Dr.Ashraf Al-Abasiry Tests for Diagnosis and Monitoring (CONT,) DIAGNOSTIC CHALLENGES AND DIFFERENTIAL DIAGNOSIS : DIAGNOSTIC CHALLENGES AND DIFFERENTIAL DIAGNOSIS ◘ Hyperventilation syndrome and panic attacks ◘ Upper airway obstruction and inhaled foreign bodies. ◘ Vocal cord dysfunction. ◘ Other forms of obstructive lung disease, particularly COPD ◘ Non-obstructive forms of lung disease (e.g., diffuse parenchymal lung disease) ◘ Non-respiratory causes of symptoms (e.g., left ventricular failure) Dr.Ashraf Al-Abasiry Slide 17: Dr.Ashraf Al-Abasiry Classification of Asthma Severity: Clinical Features Before Treatment : Classification of Asthma Severity: Clinical Features Before Treatment Days With Nights With PEF or PEF Symptoms Symptoms FEV1 Variability Step 4 Continuous Frequent £60% >30% Severe Persistent Step 3 Daily ³5/month >60%-<80% >30% Moderate Persistent Step 2 3-6/week 3-4/month ³80% 20-30% Mild Persistent Step 1 £2/week £2/month ³80% <20% Mild Intermittent Footnote: The patient’s step is determined by the most severe feature. Dr.Ashraf Al-Abasiry Slide 19: Dr.Ashraf Al-Abasiry General Guidelines for Referral to an Asthma Specialist : General Guidelines for Referral to an Asthma Specialist Diagnosis is unclear or in doubt. Unexplained clinical findings .eg crackles,clubbing,cyanosis,heart failure Spirometry or PEFs don’t fit with clinical picture.. Susbected occupational asthma. Dr.Ashraf Al-Abasiry General Guidelines for Referral to an Asthma Specialist(CONT,) : General Guidelines for Referral to an Asthma Specialist(CONT,) Persistent shortness of breath. ( not episodic,or without associated wheeze). Patient requires additional education Patient is being considered foimmunotherapy Pharmacologic Therapy : Pharmacologic Therapy Asthma is a chronic inflammatory disorderof the airways. A key principle of therapy is regulation of chronic airway inflammation. Dr.Ashraf Al-Abasiry Goals of Asthma Therapy : Goals of Asthma Therapy Prevent chronic and troublesome symptoms Maintain (near-) “normal” pulmonary function Maintain normal activity levels (including exercise and other physical activity) Prevent recurrent exacerbations and minimize the need for emergency department visits or hospitalizations Provide optimal pharmacotherapy with minimal or no adverse effects Dr.Ashraf Al-Abasiry Overview ofAsthma Medications : Overview ofAsthma Medications Daily: Long-Term Control Corticosteroids (inhaled and systemic) Cromolyn/nedocromil Long-acting beta2-agonists Methylxanthines Leukotriene modifiers As-needed: Quick Relief Short-acting beta2-agonists Anticholinergics Systemic corticosteroids Dr.Ashraf Al-Abasiry Inhaled Corticosteroids : Inhaled Corticosteroids Benefit of daily use: Fewer symptoms Fewer severe exacerbations Reduced use of quick-relief medicine Improved lung function Reduced airway inflammation Dr.Ashraf Al-Abasiry Estimated Comparative Daily Dosages of InhaledCorticosteroids for Adults : Estimated Comparative Daily Dosages of InhaledCorticosteroids for Adults Drug Low Dose Medium Dose High Dose Beclomethasone 200 - 500 mcg > 504 - 1000 mcg > 1000-2000 mcg Budesonide DPI 200 - 400 mcg > 400 - 800 mcg >800-1600 mcg Flunisolide 500 - 1,000 mcg >1,000 - 2,000 mcg >2,000 mcg Fluticasone 100 - 250 mcg > 250 - 500 mcg >500-1000 mcg Triamcinolone 400 - 1,000 mcg >1,000 - 2,000 mcg >2,000 mcg Dr.Ashraf Al-Abasiry Long-Acting Beta2-Agonists : Long-Acting Beta2-Agonists Not a substitute for anti-inflammatory therapy. Not appropriate for monotherapy. Beneficial when added to inhaled corticosteroids. Dr.Ashraf Al-Abasiry Leukotriene Modifiers : Leukotriene Modifiers Mechanisms 5-LO inhibitors Cysteinyl leukotriene receptor antagonists Indications Long-term-control therapy in mildpersistent asthma Improve lung function Prevent need for short-acting beta2-agonists Prevent exacerbations Slide 29: Theophylline. Role in therapy Theophylline is a bronchodilator and, when given in a lower dose, has modest anti-inflammatory properties. It may provide benefit as add-on therapy in patients who do not achieve control on inhaled glucocorticosteroids alone. Cromones: sodium cromoglycate and nedocromil sodium. : Cromones: sodium cromoglycate and nedocromil sodium. Role in therapy The role of sodium cromoglycate( Intal) and nedocromil sodium(Tilade) in long-term treatment of asthma in adults is limited. Efficacy has been reported in patients with mild persistent asthma and exercise-induced bronchospasm. Dr.Ashraf Al-Abasiry Slide 31: Anti-IgE. Role in therapy Anti-IgE (omalizumab) is a treatment option limited to patients with elevated serum levels of IgE. Its current indication is for patients with severe allergic asthma who are uncontrolled on inhaled glucocortico- steroids. Dr.Ashraf Al-Abasiry Allergen-specific immunotherapy : Allergen-specific immunotherapy Role in therapy Appropriate immunotherapy requires the identification and use of a single well-defined clinically relevant allergen. The later is administered in progressively higher doses in order to induce tolerance Dr.Ashraf Al-Abasiry Short-Acting Beta2-Agonists : Short-Acting Beta2-Agonists Most effective medication for relief of acute bronchospasm. More than one canister per month suggests inadequate asthma control. Regularly scheduled use is not generally recommended May lower effectiveness. May increase airway hyperresponsiveness. Systemic glucocorticosteroids : Systemic glucocorticosteroids Role in therapy Prevent progression of the asthma exacerbation. Reduce the need for referral to emergency departments and hospitalization. Prevent early relapse after emergency treatment, and reduce the morbidity of the illness. Dr.Ashraf Al-Abasiry Anticholinergics : Anticholinergics Role in therapy Anticholinergic bronchodilators used in asthma include ipratropium bromide(atrovent) and oxitropium bromide(spiriva). Inhaled ipratropium bromide is a less effective reliever medication in asthma than rapid-acting inhaled beta 2- agonists. Dr.Ashraf Al-Abasiry Asthma Management&Prevention : Asthma Management&Prevention The recommendations for asthma management are laid out in five interrelated components of therapy: 1. Develop Patient/Doctor Partnership. 2. Identify and Reduce Exposure to Risk Factors. 3. Assess, Treat, and Monitor Asthma. 4. Manage Asthma Exacerbations. 5. Special Considerations. Dr.Ashraf Al-Abasiry Patient/Doctor Partnership : Patient/Doctor Partnership Education should be an integral part of all interactions between health care professionals & patients. Dr.Ashraf Al-Abasiry Prevention of asthma symptom &exacerbation : Prevention of asthma symptom &exacerbation Identify and Reduce Exposure to Risk Factors such as: Allergens. viral infections Irritants. Exercise. breathing in cold air. weather changes. Occupational exposure. Slide 40: Dr.Ashraf Al-Abasiry MANAGEMENT OF ASTHMA EXACERBATIONS : MANAGEMENT OF ASTHMA EXACERBATIONS Dr.Ashraf Al-Abasiry ASSESSMENT OF SEVERITY : ASSESSMENT OF SEVERITY Dr.Ashraf Al-Abasiry MANAGEMENT–COMMUNITY SETTINGS : MANAGEMENT–COMMUNITY SETTINGS Dr.Ashraf Al-Abasiry MANAGEMENT–ACUTE CARE SETTINGS : MANAGEMENT–ACUTE CARE SETTINGS Dr.Ashraf Al-Abasiry Special considerations : Special considerations Pregnancy. Surgery. Rhinitis, Sinusitis, and Nasal Polyps. Occupational Asthma. Gastroesophageal Reflux. Respiratory Infections. Anaphylaxis and Asthma. Dr.Ashraf Al-Abasiry Managing Exercise-Induced Bronchospasm (EIB) : Managing Exercise-Induced Bronchospasm (EIB) Anticipate EIB in all patients Teachers and coaches need to be notified. Diagnosis History of cough, shortness of breath, chest pain or tightness, wheezing, or endurance problemsduring exercise Conduct exercise challenge OR have patientundertake task that provoked the symptoms 15% decrease in PEF or FEV1 is compatible with EIB Dr.Ashraf Al-Abasiry Slide 47: Management Strategies Short-acting inhaled beta2-agonists used shortly before exercise last 2 to 3 hours Salmeterol or formeterol may prevent EIB for 10 to 12 hours Cromolyn and nedcromil are also acceptable A lengthy warmup period before exercise may preclude medications for patients who can tolerate it Long-term-control therapy, if appropriate Dr.Ashraf Al-Abasiry Slide 48: Dr.Ashraf Al-Abasiry You do not have the permission to view this presentation. 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Bronchial Asthma (د/ أشرف الأباصيري ) ashrafalabasiry Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 6107 Category: Education License: All Rights Reserved Like it (11) Dislike it (0) Added: September 22, 2008 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: abearahmed2012 (1 month(s) ago) very very excellent presentation ,please can I have it. Saving..... Post Reply Close Saving..... Edit Comment Close By: ahmad2145 (11 month(s) ago) Very nice and excelent presentation can I take it to benefet from it Saving..... Post Reply Close Saving..... Edit Comment Close By: hossam7500 (12 month(s) ago) thnks. can i have it? Saving..... Post Reply Close Saving..... Edit Comment Close By: delan_iraq (12 month(s) ago) nice it is very good presenation can i have it Saving..... Post Reply Close Saving..... Edit Comment Close By: matkurt (16 month(s) ago) thnks. can i have it? Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Slide 1: SUMMARY By Dr.Ashraf Al-Abasiry,MBBCh,MSc Internist,Primary Care Department Saad Specialist Hospital Email: ashrafalabasiry@yahoo.com Definition : Definition ◘ Asthma is a chronic inflammatory disorder of the airways It is associated with airway hyperresponsiveness that leads to recurrent episodes of: wheezing,breathlessness, chest tightness and coughing, particularly at night or in the early morning. Dr.Ashraf Al-Abasiry Factors Influencing the Development and Expression of asthma : Factors Influencing the Development and Expression of asthma HOST FACTORS Genetic, e.g., Genes pre-disposing to atopy Genes pre-disposing to airway hyperresponsiveness. Obesity Sex Dr.Ashraf Al-Abasiry Slide 4: ENVIRONMENTAL FACTORS • Allergens Indoor: Domestic mites, furred animals (dogs, cats, mice), cockroach allergen, fungi, molds, yeasts Outdoor: Pollens, fungi, molds, yeasts Infections (predominantly viral) Occupational sensitizers • Tobacco smoke. Passive smoking/Active smoking. • Outdoor/Indoor Air Pollution. • Diet. Dr.Ashraf Al-Abasiry Slide 5: Dr.Ashraf Al-Abasiry MECHANISMS OF ASTHMA : MECHANISMS OF ASTHMA ◘ Asthma is an inflammatory disorder of the airways, which involves several inflammatory cells and multiple mediators that result in characteristic pathophysiological changes. ◘ This pattern of inflammation is strongly associated with airway hyper- responsiveness and asthma symptoms. Slide 7: Environmental risk factors (causes) INFLAMMATION Airway Airflow hyperresponsiveness limitation Precipitants Adapted with permission from Stephen T. Holgate, M.D., D.Sc. Symptoms Asthma is a chronic inflammatory disorder of the airways. Slide 8: Dr.Ashraf Al-Abasiry Clinical Diagnosis : Clinical Diagnosis Medical History Symptoms: Episodic breathlessness, wheezing, cough, and chest tightness. Episodic symptoms occur after an incidental allergen exposure. Seasonal variability of symptoms and a positive family history of asthma and atopic disease are also helpful diagnostic guides. Dr.Ashraf Al-Abasiry Physical Examination : Physical Examination Signs of an asthmatic attack are: wheezing, tachypnea, prolonged expiration, tachycardia, rhonchous lung sounds ,and over-inflation of the chest. During a serious asthma attack, the accessory muscles of respiration may be used, and the presence of a paradoxical (a pulse that is weaker during inhalation and stronger during exhalation). Tests for Diagnosis and Monitoring : Tests for Diagnosis and Monitoring 1- Measurements of lung function. Measurements of lung function, and particularly the demonstration of reversibility of lung function abnormalities, greatly enhance diagnostic confidence. Two methods have gained widespread acceptance for use in patients over 5 years of age. These are spirometry, and peak expiratory flow (PEF) measurement Dr.Ashraf Al-Abasiry Slide 12: Spirometry : is the recommended method of measuring airflow limitation and reversibility to establish a diagnosis of asthma to demonstrate reversibility FEV1 < 80% predicted; FEV1/FVC <65% or below the lower limit of normal FEV1 increases >12% and at least 200 mL after using a short-acting inhaled beta2-agonist Dr.Ashraf Al-Abasiry Slide 13: Peak expiratory flow measurements are made using a peak flow meter and can be an important aid in both diagnosis and monitoring of asthma. measurements should preferably be compared to the patient’s own previous best measurements using his/her own peak flow meter. Dr.Ashraf Al-Abasiry Slide 15: 2- Measurement of airway responsiveness. 3- Non-invasive markers of airway inflammation. 4- Measurements of allergic status. Dr.Ashraf Al-Abasiry Tests for Diagnosis and Monitoring (CONT,) DIAGNOSTIC CHALLENGES AND DIFFERENTIAL DIAGNOSIS : DIAGNOSTIC CHALLENGES AND DIFFERENTIAL DIAGNOSIS ◘ Hyperventilation syndrome and panic attacks ◘ Upper airway obstruction and inhaled foreign bodies. ◘ Vocal cord dysfunction. ◘ Other forms of obstructive lung disease, particularly COPD ◘ Non-obstructive forms of lung disease (e.g., diffuse parenchymal lung disease) ◘ Non-respiratory causes of symptoms (e.g., left ventricular failure) Dr.Ashraf Al-Abasiry Slide 17: Dr.Ashraf Al-Abasiry Classification of Asthma Severity: Clinical Features Before Treatment : Classification of Asthma Severity: Clinical Features Before Treatment Days With Nights With PEF or PEF Symptoms Symptoms FEV1 Variability Step 4 Continuous Frequent £60% >30% Severe Persistent Step 3 Daily ³5/month >60%-<80% >30% Moderate Persistent Step 2 3-6/week 3-4/month ³80% 20-30% Mild Persistent Step 1 £2/week £2/month ³80% <20% Mild Intermittent Footnote: The patient’s step is determined by the most severe feature. Dr.Ashraf Al-Abasiry Slide 19: Dr.Ashraf Al-Abasiry General Guidelines for Referral to an Asthma Specialist : General Guidelines for Referral to an Asthma Specialist Diagnosis is unclear or in doubt. Unexplained clinical findings .eg crackles,clubbing,cyanosis,heart failure Spirometry or PEFs don’t fit with clinical picture.. Susbected occupational asthma. Dr.Ashraf Al-Abasiry General Guidelines for Referral to an Asthma Specialist(CONT,) : General Guidelines for Referral to an Asthma Specialist(CONT,) Persistent shortness of breath. ( not episodic,or without associated wheeze). Patient requires additional education Patient is being considered foimmunotherapy Pharmacologic Therapy : Pharmacologic Therapy Asthma is a chronic inflammatory disorderof the airways. A key principle of therapy is regulation of chronic airway inflammation. Dr.Ashraf Al-Abasiry Goals of Asthma Therapy : Goals of Asthma Therapy Prevent chronic and troublesome symptoms Maintain (near-) “normal” pulmonary function Maintain normal activity levels (including exercise and other physical activity) Prevent recurrent exacerbations and minimize the need for emergency department visits or hospitalizations Provide optimal pharmacotherapy with minimal or no adverse effects Dr.Ashraf Al-Abasiry Overview ofAsthma Medications : Overview ofAsthma Medications Daily: Long-Term Control Corticosteroids (inhaled and systemic) Cromolyn/nedocromil Long-acting beta2-agonists Methylxanthines Leukotriene modifiers As-needed: Quick Relief Short-acting beta2-agonists Anticholinergics Systemic corticosteroids Dr.Ashraf Al-Abasiry Inhaled Corticosteroids : Inhaled Corticosteroids Benefit of daily use: Fewer symptoms Fewer severe exacerbations Reduced use of quick-relief medicine Improved lung function Reduced airway inflammation Dr.Ashraf Al-Abasiry Estimated Comparative Daily Dosages of InhaledCorticosteroids for Adults : Estimated Comparative Daily Dosages of InhaledCorticosteroids for Adults Drug Low Dose Medium Dose High Dose Beclomethasone 200 - 500 mcg > 504 - 1000 mcg > 1000-2000 mcg Budesonide DPI 200 - 400 mcg > 400 - 800 mcg >800-1600 mcg Flunisolide 500 - 1,000 mcg >1,000 - 2,000 mcg >2,000 mcg Fluticasone 100 - 250 mcg > 250 - 500 mcg >500-1000 mcg Triamcinolone 400 - 1,000 mcg >1,000 - 2,000 mcg >2,000 mcg Dr.Ashraf Al-Abasiry Long-Acting Beta2-Agonists : Long-Acting Beta2-Agonists Not a substitute for anti-inflammatory therapy. Not appropriate for monotherapy. Beneficial when added to inhaled corticosteroids. Dr.Ashraf Al-Abasiry Leukotriene Modifiers : Leukotriene Modifiers Mechanisms 5-LO inhibitors Cysteinyl leukotriene receptor antagonists Indications Long-term-control therapy in mildpersistent asthma Improve lung function Prevent need for short-acting beta2-agonists Prevent exacerbations Slide 29: Theophylline. Role in therapy Theophylline is a bronchodilator and, when given in a lower dose, has modest anti-inflammatory properties. It may provide benefit as add-on therapy in patients who do not achieve control on inhaled glucocorticosteroids alone. Cromones: sodium cromoglycate and nedocromil sodium. : Cromones: sodium cromoglycate and nedocromil sodium. Role in therapy The role of sodium cromoglycate( Intal) and nedocromil sodium(Tilade) in long-term treatment of asthma in adults is limited. Efficacy has been reported in patients with mild persistent asthma and exercise-induced bronchospasm. Dr.Ashraf Al-Abasiry Slide 31: Anti-IgE. Role in therapy Anti-IgE (omalizumab) is a treatment option limited to patients with elevated serum levels of IgE. Its current indication is for patients with severe allergic asthma who are uncontrolled on inhaled glucocortico- steroids. Dr.Ashraf Al-Abasiry Allergen-specific immunotherapy : Allergen-specific immunotherapy Role in therapy Appropriate immunotherapy requires the identification and use of a single well-defined clinically relevant allergen. The later is administered in progressively higher doses in order to induce tolerance Dr.Ashraf Al-Abasiry Short-Acting Beta2-Agonists : Short-Acting Beta2-Agonists Most effective medication for relief of acute bronchospasm. More than one canister per month suggests inadequate asthma control. Regularly scheduled use is not generally recommended May lower effectiveness. May increase airway hyperresponsiveness. Systemic glucocorticosteroids : Systemic glucocorticosteroids Role in therapy Prevent progression of the asthma exacerbation. Reduce the need for referral to emergency departments and hospitalization. Prevent early relapse after emergency treatment, and reduce the morbidity of the illness. Dr.Ashraf Al-Abasiry Anticholinergics : Anticholinergics Role in therapy Anticholinergic bronchodilators used in asthma include ipratropium bromide(atrovent) and oxitropium bromide(spiriva). Inhaled ipratropium bromide is a less effective reliever medication in asthma than rapid-acting inhaled beta 2- agonists. Dr.Ashraf Al-Abasiry Asthma Management&Prevention : Asthma Management&Prevention The recommendations for asthma management are laid out in five interrelated components of therapy: 1. Develop Patient/Doctor Partnership. 2. Identify and Reduce Exposure to Risk Factors. 3. Assess, Treat, and Monitor Asthma. 4. Manage Asthma Exacerbations. 5. Special Considerations. Dr.Ashraf Al-Abasiry Patient/Doctor Partnership : Patient/Doctor Partnership Education should be an integral part of all interactions between health care professionals & patients. Dr.Ashraf Al-Abasiry Prevention of asthma symptom &exacerbation : Prevention of asthma symptom &exacerbation Identify and Reduce Exposure to Risk Factors such as: Allergens. viral infections Irritants. Exercise. breathing in cold air. weather changes. Occupational exposure. Slide 40: Dr.Ashraf Al-Abasiry MANAGEMENT OF ASTHMA EXACERBATIONS : MANAGEMENT OF ASTHMA EXACERBATIONS Dr.Ashraf Al-Abasiry ASSESSMENT OF SEVERITY : ASSESSMENT OF SEVERITY Dr.Ashraf Al-Abasiry MANAGEMENT–COMMUNITY SETTINGS : MANAGEMENT–COMMUNITY SETTINGS Dr.Ashraf Al-Abasiry MANAGEMENT–ACUTE CARE SETTINGS : MANAGEMENT–ACUTE CARE SETTINGS Dr.Ashraf Al-Abasiry Special considerations : Special considerations Pregnancy. Surgery. Rhinitis, Sinusitis, and Nasal Polyps. Occupational Asthma. Gastroesophageal Reflux. Respiratory Infections. Anaphylaxis and Asthma. Dr.Ashraf Al-Abasiry Managing Exercise-Induced Bronchospasm (EIB) : Managing Exercise-Induced Bronchospasm (EIB) Anticipate EIB in all patients Teachers and coaches need to be notified. Diagnosis History of cough, shortness of breath, chest pain or tightness, wheezing, or endurance problemsduring exercise Conduct exercise challenge OR have patientundertake task that provoked the symptoms 15% decrease in PEF or FEV1 is compatible with EIB Dr.Ashraf Al-Abasiry Slide 47: Management Strategies Short-acting inhaled beta2-agonists used shortly before exercise last 2 to 3 hours Salmeterol or formeterol may prevent EIB for 10 to 12 hours Cromolyn and nedcromil are also acceptable A lengthy warmup period before exercise may preclude medications for patients who can tolerate it Long-term-control therapy, if appropriate Dr.Ashraf Al-Abasiry Slide 48: Dr.Ashraf Al-Abasiry