BONCHIAL ASTHMA

1. Definition - 

Reversible by bronchodilator

Recurrent episode

Chronic airway inflammaton

Triggered by multitrigger

Heterogenous (not single thing, change phenotype)

2. Different phenotype

- Allergic Asthma (most common)

- Excercise Induce

- Non Allergy

* United Airway Disease - Upper and lower airway (Allergy Rhinitis + Asthma)

3. Patophysiology

Trigger - Hyperresponse - Narrowing – Symptoms

4. Risk Factor for asthma

- Food (Allergy)

- Eczema

- Asthma

- Allergic Rhinitis

5. Physical Examination

- Harrison Sulci (asthma, possible ricket juga) - sign chronicity

- Wheezing

- Recession

- Pigeon Chest

6. Make diagnosis

- Base on history and clinical exam

7. Assesment Asthma Severity

- Persistent : Start corticosteroid

8. Asses asthma control

9. Before step up medication

- Assess Technique

- Compliance

- Trigger (smokers)

- Co morbidities

10. GINA assessment

11. Steping up treatment

- LABA- Long acting Beta Agonist

- Increase dose LABA

- Steroid

12. Mx acute asthma

- Admission

~ Failure home treatment

If you think pt exacerbation, give patient steroid (short course also can give - 3 days)

✓ Mild - use inhaler (and steroid)

✓ Moderate - Nebulizer

✓ Severe (cynose, talk in word) 

Life threatening (silent chest, unable to speak)

➢ Mild 

o Neb salbutamol

o Oral prednisolone 1mg/kg/ day x 3@5 dayNeb Salbutamol

➢ Moderate        

o +|- Ipratropium Bromide (anticholinergic)

o Oxygen 8L facemask for moderate case

 

13. Management Intubated patient

- Cont IVI Salbutamol
- Aminophyline
- Mgso4
- Corticosteroid
- Iprapropium Bromide

14. Monitoring patient with acute exacerbation

- PEFR – peak expiratory flow rate

- Spo2

- ABG (usually VBG in practical)

- Chest X ray (if not improving, we look for pneumothorax)

- ABX ( if only there is sign infection)

15. Montelukast - who can we give?

- Adjunct Allergic Rhinitis

- Viral Induce Wheeze