Asthma Approachk

Approach to Bronchial
asthma in phc setting
By : Dr.Kawther Alismail
Family Medicine Specialist
Asthma Definition
▪BA is a chronic inflammatory airways disease characterized by
- hyper-responsiveness inflammation
- reversible obstruction
- relived either spontaneously or with treatment.
The main symptoms:
Shortness of Breath.
Wheezing.
Chest Tightness.
Cough lasting more than a week.
chronic or recurrent or nocturnal
But during Episodes of Asthma
The lining of the airway become swollen (inflamed).
The airway produce a thick mucus
The muscles around the airway tighten & make it narrower

What are the Causes of
Asthma Episodes?
The basic causes of asthma is not yet known
The common triggers for Asthma Episodes Include:-
* Dander * House Dust Mites

* Cockroaches * Pollens from grass & Trees
* Molds (in & outdoor) * Smoke
* Exercise * Crying or Laughing
* Infection of Upper Airway ( cold)
* Change in Weather & Temperature
• Normal between attacks
• Vital signs
• General appearance
• Holistic Physical Exam (Peripheral to central
approach)
• Prolonged expiration.
• Bilateral expiratory wheezing.
• ronchi.
• O2 Pulse oximeter
• Consider alternative Dx when there is
localized:
➢ wheeze and crackles,
➢ stridor
➢ clubbing
Differntial diagnosis
▪ RESPIRATORY :
➢ Infections
➢ -foreign body
➢ -cystic fibrosis
➢ -laryngotrachomalacia
➢ -bronchiectasis
➢ -hypersensitivity pneumonitis.
➢ TB
➢ COPD
GASTROINTESTINAL :
➢ Gastroesophageal reflex –
➢ H type tracheoesophageal fistula
▪ CARDIOVASCULAR:
➢ Congenital heart diseases (CHD)
Peak Expiratory Flow Rate
PEFR can help you and your doctor to:-

Decide if your medicine plan is working well.
Decide when to add or stop medicine.
Decide when to seek emergency care.
Identify triggers that is, what causes your asthma
symptoms to increase.
Talk about your asthma with more knowledge.
How to Use a PEFR ?
❖ Place the indicator at the base of the numbered scale.

❖ Stand Up.
❖ Take a deep breath.
❖ Place the meter in your mouth & close your lips around
the mouthpiece. Do not put your tongue inside the hole.
❖ Blow out as hard & fast as you can.
❖ Write down the number you get.
❖ Repeat steps 1 to 6 three times more.
❖ Write down the highest of the three number achieved.
Goals of Asthma Management
Be active with out having asthma symptoms.
Sleeping with out asthma symptoms.
Prevent asthma episodes ( attacks ).
Have the best Possible PFER.
Avoid side effects from asthma medicines.

How can Asthma Episodes
be Prevented?
Develop plan that PREVENT symptom.
The Plan is to avoid or reduce contact with triggers.
How to control it ?
Have a medicine plan to control asthma episodes, Include:-
Avoid triggers
Treating symptoms EARLY
What Medicines are Used
to Treat Asthma?
There are two kinds of medicines:
Bronchodilators controller
reliver Anti-Inflammatory
GINA what's new?
• Regular or frequent use of SABA is associated with
adverse effects
• b-receptor downregulation, decreased
bronchoprotection, rebound hyperresponsiveness,
• decreased bronchodilator response
• Increased allergic response, and increased eosinophilic

airway inflammation
• ICS-containing controller treatment
Drugs Route
of Administration
Meter Dose Inhaler ( MDI )

Dry Powder Inhaler (Turbohaler)(diskus)
Nebulizer
Powder Idled Capsule (Handihaler)
Tablet ( corticosteroids )
IV ( corticosteroids )
How to Use?
LEVEL OF CONTROL TREATMENT OPTION
controlled Step down therapy
Maintain therapy
Partly controlled Maintain therapy
Step up therapy
Uncontrolled Step up therapy
Look up for reasons

Refferal
Status asthmatics
Deteriorating PEF
Persisting or worsening hypoxia
Hypercapnea, respiratory acidosis (pH
<7.3)
Severe exhaustion
Increase work of breathing
Drowsiness
Confusion
Coma
Respiratory arrest
Traffic Light Zone
- Green ( 80% – 100% ) Safe Side

Use your Preventive Medication
- Yellow ( 50% - 80% ) Cautions

Use your Rescuer Medication
- Red ( < 50% ) Medical Alert

Go to Emergency Room
Asthma And
Pregnancy
Things to be aware of
Asthma symptoms will become worse for about 1/3 of

pregnant women.
Asthma symptoms may be most sever between 29-36

weeks of pregnancy.
Asthma that’s not under control may affect health of

your baby as well as your own health.
Do not do
Do not have large volumes of liquids to drink.
Do not breathe warm, moist air.
Do not rebreathe into a bag held tightly over your
nose & mouth.
Do not use over-the-counter cold remedies
without first calling the doctor.

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Approach to Bronchial

asthma in phc setting

The lining of the airway become swollen (inflamed).

The airway produce a thick mucus

The muscles around the airway tighten & make it narrower

The basic causes of asthma is not yet known

The common triggers for Asthma Episodes Include:-

* Dander * House Dust Mites

PEFR can help you and your doctor to:-

❖ Place the indicator at the base of the numbered scale.

Be active with out having asthma symptoms.

Sleeping with out asthma symptoms.

Prevent asthma episodes ( attacks ).

Have the best Possible PFER.

Avoid side effects from asthma medicines.

The Plan is to avoid or reduce contact with triggers.

• Increased allergic response, and increased eosinophilic

Meter Dose Inhaler ( MDI )

controlled Step down therapy

Partly controlled Maintain therapy

Uncontrolled Step up therapy

Look up for reasons

- Green ( 80% – 100% ) Safe Side

- Yellow ( 50% - 80% ) Cautions

- Red ( < 50% ) Medical Alert

Asthma symptoms will become worse for about 1/3 of

Asthma symptoms may be most sever between 29-36

Asthma that’s not under control may affect health of

Do not have large volumes of liquids to drink.

Do not breathe warm, moist air.

Do not rebreathe into a bag held tightly over your

nose & mouth.

Do not use over-the-counter cold remedies

without first calling the doctor.

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