Bronchial AsthmaBronchial Asthma

Dr Enmei LiuDr Enmei Liu

Division of Respiratory DisordersDivision of Respiratory Disorders

Children’s HospitalChildren’s Hospital

Asthma is a Major Public Health Problem

• Nearly 5 million children have asthma (6.9% of children under 18)

• It is one of the most common chronic childhood illnesses

• It is a leading cause of school absences

2 or more children are likely to have asthma

In a classroom of 30 children,

Totally 1.5 billion asthma patients in the world

Eighteen thousand patients died for asthma

Cost for asthma therapy more than that for AIS and TB

Thirty million asthma patient in our contry

Asthma –a global disease

EpidemiologyEpidemiology Increase in the prevalence of

asthma: incidence of asthma from1.65% to

5.33%

In childhood,Male:Female=2:1

“Asthma” come from Greek, means “Wheezing”

In 1994, 17 countries in WHO

GINA Global Initiative for Asthma

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.

What is Asthma?

A disease that:• Is chronic• Produces recurring episodes of breathin

g problemsCoughingWheezingChest tightnessShortness of breath

Environmental factors Genetic predisposition

Bronchial Inflammation

Bronchial Hyperreactivity+trigger factors

Oedema

Bronchoconstriction

Mucus Production

Airways Narrowing

Symptoms

Upper respiratory tract infectionAllergensExerciseEmotional upset

What are the Symptoms of Asthma?

• Shortness of breath• Wheezing• Tightness in the chest• Coughing at night or after physical activity; co

ugh that lasts more than a week• Waking at night with asthma symptoms (a key

marker of uncontrolled asthma)

What Happens During an Episode of Asthma?

• The lining of the airways becomes swollen (inflamed)

• The airways produce a thick mucus• The muscles around the airways tighten and

make airways narrower

What Makes Asthma Worse?

• AllergensWarm-blooded pets (including dogs, cats,

birds, and small rodents)House dust mitesCockroachesPollens from grass and treesMolds (indoors and outdoors)

What Makes Asthma Worse?

• Irritants Cigarette smoke and wood smoke Scented products such as hair spray, cosmetics, a

nd cleaning products Strong odors from fresh paint or cooking Automobile fumes and air pollution Chemicals such as pesticides and lawn treatments

What Makes Asthma Worse?

• Infections in the upper airways, such as colds (a common trigger for both children and adults)

• Exercise• Strong expressions of feelings (crying, laughi

ng)• Changes in weather and temperature

Diagnosis of AsthmaDiagnosis of Asthma Clinical typical symptoms of recurre

nt wheeze,cough and breathlessnessPersonal and family history of atopic

diseaseExclude other wheezing disorders

InvestigationInvestigation Eosinophil-eosinphiliaSerum IgESkin testChest X-ray:hyperinflationLung function:peak flow meter, peak

expiratory flow rate(PEFR)

Differential DiagnosisDifferential Diagnosis Brochiolitis Inhaled foreign bodyTuberculosis Congenital abnormality of lung, airw

ay or heat idiopathic

Is There A Cure For Asthma?

Asthma cannot be cured,but it can be controlled.

You should expect nothing less.

How Is Asthma Controlled?

• Follow an individualized asthma management plan

• Avoid or control exposure to things that make asthma worse

• Use medication appropriately Long-term-control medicine Quick-relief medicine

Drugs in Asthma

Type of Drug Drug

Beta2 bronchodilators

Short-acting Salbutamol

Long-acting Salmeterol

Anticholinergic bronchodilator Ipratropium Bromide

Preventative/prophylactic treatment

Inhaled steroids Budesonide

Beclomethasone

Fluticasone

Sodium cromoglycate

Methyl xanthines Theophylline

Oral steroids Prednisolone

How Is Asthma Controlled?

• Monitor response to treatment Symptoms Peak flow

• Get regular follow-up care

How are Asthma Episodes Controlled?

• Know the signs that asthma is worsening• Treat symptoms or drop in peak flow at first si

gns of worsening• Monitor response to therapy• Seek a doctor’s help when it is needed

What Should People with Asthma Be Able To Do?

• Be active without having asthma symptoms; this includes participating in exercise and sports

• Sleep through the night without having asthma symptoms

• Prevent asthma episodes (attacks)• Have the best possible lung function (e.g., go

od peak flow number)• Avoid side effects from asthma medicines

Case StudyCase Study

HistoryHistoryAn 8-month-old girl presented to the emergency room in respiratory distress associated with wheezing and a temperature of 38.8C. She had been ill for 2-3 days with a “cold and have awoken that morning with tachypnea, cough, and wheezing.She had had a similar episode about 2 months before. In addition, she had a chronic pruritic rash on the face, trunk, and extremeties for 2 months which improved when treated with cortisone-type cream. Her nose was always “running” according to the mother. She had been a very colicky baby for the first 6 months, but not “bothered” by milk at present. A 10-ear-old brother had had a similar history in infancy, but had “outgrown” these problems, having only occasional hay fever now.

Physical ExaminationPhysical Examination

The infant was tachypneic, coughing and crying with slight duskiness of the lips. Nasal exam showed swollen, red nasal turbinates.There was increased anterior-posterior diameter of the chest with marked retractions. On auscultation the air exchange was good with rhonchi and diffuse wheezes heard throughout both lung fields. An eczematous type rash was noted on the face,trunk, and extremities. The child was given an adrenalin shot with only slight improvement. She was, therefore, admitted to the ward.

Laboratory DataLaboratory Data

Chest film showed marked hyperaeration with no evidence of pneumonia

CBC (complete blood count) showed normal

Viral cultures several weeks later reported the recovery of respiratory syncycial virus (RSV).

Clinical CourseClinical Course

After several days of supportive measures including

intravenous hydration and oxygen

She made an uneventful recovery.

QuestionsQuestions

This child probably has :

• recurrent brochiolitis

• bronchial asthma

• asthmatic bronchitis

• wheezy bronchitis

Which of the following suggests the correct diagnosis?

A.     History of previous episodes

B.     Response to adrenalin

C.     Family history

• Presence of eczema, rhinitis, and

possible allergic gastroenteritis

Answer this question true or false

The isolation of RSV helps distinguish

bronchiolitis from asthma.

Which test might be useful in distinguishing bronchiolitis from asthma?

A.     Peripheral blood and nasal

eosinophilia

B.     Total serum IgE

C.     Allergic skin tests

D. All of the above

The most useful therapeutic Modalities for this child’s immediate problem include

A.     adequate hydration

B.     humidified oxygen

C.     antibiotics

• bronchodilators

• steroids

To prevent future episode, which measures should be taken?

A.     Allergy workup

B.    Good dust and animal avoidance

C.     Nothing, since the child will

outgrow this

D. Elimination diet