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Izzatullah Khan
Assistant Professor
Pharm.D (BMU) MSc. (UK)
Contents
INTRODUCTION TO RESPIRATORY
SYSTEM
Asthma means
laboured breathing ----In Greek
---The national UK guidelines define Asthma as :
EPIDEMIOLOGY
Over 5 million people in the UK ,have asthma &
around 300 million world wide.
In the UK, there are approximately 1400 deaths
from asthma each year.
Probability of children having asthma symptoms
is between 5 to 12 % with high occurrence in boys
than girls.
ETIOLOGY
The two main causes of
asthma symptoms are:
Airway
hyperresponsiveness
Increased tendency
of the airway to react
to stimuli or triggers
to cause an asthma
attack.
Bronchoconstriction
A narrowing of
airways that
causes airflow
obstructions.
Trigger
Examples
Allergens
Pollens
Moulds
Animals (dander, saliva ,urine)
Industrial chemicals
Drugs
Aspirin
Ibuprofen
Prostaglandin synthetase inhibitor
Foods
Dairy products
Nuts
Sea foods
Environmental
pollutants
Traffic fumes
Cigarette smoke
Other industrial
triggers
Miscellaneous
Cold air
Viral respiratory tract infections
Emotions or stress
Pathophysiology
Antigen
(allergen)
IgE antibody
antigen
reaction
Neutrophil
Eosinophil
Bronchial
hyperactivity
Mucosal
edema
Hypertrophy &
Hyperplasia of bronchial
smooth muscles
Increased mucus
production
Airway plugging
Airway edema
Acute bronchoconstriction
CLINICAL
MANIFESTATIONS
Persistent cough
Dyspnoea(difficulty in breathing)
Wheezing(a high-pitched noise due to turbulent airflow through a
narrow airway)
Breathlessness
Hyper expansion of the thoracic cavity & lowering of the
diaphragm.
Difficulty is felt both during inspiration and expiration.
Severe contraction of abdominal muscles.
In asthma
Residual volume
Functional residual capacity
(FRC)
increased
Decreased
Investigations
1.. Forced expiratory volume (FEV1):
Measure of the FEV in the first second of exhalation.
2.. Forced vital capacity (FVC):
Assessment of the maximum volume of air exhaled with maximum effort after maximum inspiration.
Percentage of total volume of air
exhaled=FEV1/FVC
Normal individual can exhale 70% or their capacity in 1 sec.
In Asthma
In asthma
FVC
FEV1
Decreases
FEV1:FVC
Remains
normal /slightly
decreases
Diagnosis:
Diagnosing asthma generally includes:
Medical history
Physical examination
Pulmonary function test
Furthermore it can be confirmed by measuring the
response to a bronchodilator by examining a
patients day to day variation in PEF readings.
A diurnal variability of 60L/min (or more than
20%) is highly suggestive in asthma.
Management
A: Non pharmacological management
B: pharmacological management
Non pharmacological
management
Supervised swimming : helps to avoid exercise
induced attacks
Avoid skipping
Avoid all trigger factors
Pharmacological
Treatment
Reliever medication
Preventive medication
1..Reliever medication
Classes
Drugs
Route of
administration
Inhaled
Nebulised
Inhaled
Combination
therapy
ICS/LABA
Inhaled
(budesonide/formeterol)
2..Preventive medications
Classes
Drugs
Anti-inflammatory agents
1..Inhaled corticosterods:
Beclometasone diproprionate
or budesonide
2..Cromones:
Sodium cromoglicate
Nedocromil sodium
Leukotriene receptor
antagonists
Zafirlukast
Montelukast
Omalizumab
Oral corticosteroids
Glucocorticoids
mineralocorticoids
Methotrexate
Ciclosporin
References
Clinical pharmacy and therapeutics edited by Roger Walker and cate
whittlesea,5th edition, page no. 412-430
Clinical pharmacy written by Irfan Bashir, revised edition, page no.
258-262
Basic pathology written by Robbins,8th edition, page no. 489-492
Essentials of medical physiology written by K Sembulingam and Prema
Sembulingam,5th edition, page no. 703
Asthma in Adult, http://bestpractice.bmj.com/bestpractice/monograph/44/basics/pathophysiology.html