OVERVIEW OF Bronchial Asthma DR P YUGANDHAR M
OVERVIEW OF Bronchial Asthma DR. P. YUGANDHAR M. D. , PROFESSOR DEPARTMENT OF PULMONOLOGY ASRAM MEDICAL COLLEGE, PRAGNA CHEST CLINIC, R. R. , PET ELURU
“All that wheeze is not asthma All asthmatics do not wheeze”
DEFINITION OF ASTHMA A Chronic Inflammatory Disorder of the airways Many cells and cellular elements play a role Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing Widespread, variable, and often reversible airflow limitation GINA: Updated 2008
HOW TO DIAGNOSE BRONCHIAL ASTHMA 1. CLINICAL DIAGNOSIS OF ASTHMA IS MADE BY SYMPTOMS OF EPISODIC BREATHLESSNESS, WHEEZING, CHEST TIGHTNESS AND COUGH. 2. MEASUREMENTS OF LUNG FUNCTION BY SPIROMETRY/PEAKFLOW METER PROVIDE INFORMATION ABOUT THE SEVERITY, REVERSIBILITY AND VARIABILITY OF AIRFLOW OBSTRUCTION AND HELP TO CONFIRM DIAGNOSIS OF ASTHMA. 3. EXTRA MEASURES MAY BE REQUIRED TO DIAGNOSE ASTHMA IN CHILDREN <5 yrs, ELDERLY AND OCCUPATIONAL ASTHMA.
5. MEASUREMENT OF ALLERGY STATUS CAN HELP TO IDENTIFY RISK FACTORS THAT CAUSE ASTHMA IN INDIVIDUAL PATIENTS. 6. FOR PATIENTS WITH SYMPTOMS CONSISTENT WITH ASTHMA, BUT NORMAL LUNG FUNCTION MEASUREMENT OF AIRWAY HYPERRESPONSIVENESS MAY HELP CONFIRM THE DIAGNOSIS.
EPIDEMIOLOGY The global prevalence ranges from 1%-18% of population in different countries According to World Health Organisation (WHO 2005). . 300 million people suffer from Asthma In India, 57, 000 deaths were attributed to Asthma in 2004 (WHO 2004) Seen as one of the leading cause of morbidity and mortality in rural India (Smith 2000) World Health Organization. The global burden of disease: 2004 update. Geneva, WHO, 2008. Smith KR. National Burden of disease in India from indoor air pollution. 2000. Proc Natl Acad Sci USA. Nov 21, 97(24). 13286 -93 .
ASTHMA: FACTS AND FIGURES (WORLD)
CLASSIFICATION OF ASTHMA SEVERITY BASED ON NAEPP CLASSIFICATION OF SYMPTOMS J Managed Care Pharm. 2003; 9(6): 534 -43
ASTHMA EMERGENCY DEPARTMENT VISITS, 2001 J Managed Care Pharm. 2003; 9(6): 534 -43
ASTHMA HOSPITALIZATIONS, 2001 J Managed Care Pharm. 2003; 9(6): 534 -43
ASTHMA: FACTS AND FIGURES (INDIA)
EPIDEMIOLOGY: ASTHMA & COPD Estimated Number of Obstructive Airway Disease Patients in India 1. Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2008
ESTIMATES OF PREVALENCE RATES OF CHRONIC ASTHMA BY AGE (CASES/LAC PERSONS) 1. Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2008
PREVALENCE OF ACUTE ASTHMA IN DIFFERENT AGE GROUPS 1. Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2008
CURRENT COST OF TREATMENT OF ASTHMA (RS/PATIENT) PER YEAR 1. Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2008
MECHANISMS OF ASTHMA
MECHANISMS UNDERLYING THE DEFINITION OF ASTHMA Risk Factors (for development of asthma) INFLAMMATION Airway Hyperresponsiveness Risk Factors (for exacerbations) Airflow Obstruction Symptoms
Asthma Inflammation: Cells and Mediators Source: Peter J. Barnes, MD
Mechanisms: Asthma Inflammation Source: Peter J. Barnes, MD
Asthma Inflammation: Cells and Mediators Source: Peter J. Barnes, MD
LEUKOTRIENES IN PATHOPHYSIOLOGY OF ASTHMA
LEUKOTRIENES IN PATHOPHYSIOLOGY OF ASTHMA Gawchik SM et al. Role of antileukotriene agents in asthma therapy. JAOA, Vol 100. No 1, Jan 2000.
DIFFERENTIAL DIAGNOSIS IN ADULTS 1. COPD 2. LVF(CARDIAC ASTHMA) 3. LOCALISED NARROWING OF MAJOR AIRWAYS-TUMOR OR TRACHEAL STENOSIS 4. FUNCTIONAL OBSTRUCTION OF UPPER AIRWAY-ESPECIALLY IN YOUNG WOMEN(HYPERVENTILATION SYNDROME AND PANIC ATTACKS) 5. VOCAL CORD DYSFUNCTION.
D/D IN CHILDREN 1. CHRONIC RHINO SINUSITIS 2. GASTRO ESOPHAGEAL DISEASE 3. TUBERCULOSIS 4. CYSTIC FIBROSIS 5. CILIARY DYSKINESIAS 6. FOREIGN BODY ASPIRATION 7. CONGENITAL MALFORMATIONS AND ANAMOLIES OF THE RESPIRATORY TRACT. 8. CONGENITAL HEART DISEASE
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