Sponsored Links
This presentation is the property of its rightful owner.
1 / 40

Asthma PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

Asthma. Renmin Hospital, Wuhan University Ding Xuhong ( 丁续红 ). DEFINITION A clinical syndrome of unknown etiology characterized by three distinct components (1) Recurrent episodes of airway obstruction that resolve spontaneously or as a result of treatment (clinical manifestation).

Download Presentation


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Renmin Hospital, Wuhan University

Ding Xuhong (丁续红)


A clinical syndrome of unknown etiology characterized by three distinct components

(1)Recurrent episodes of airway obstruction that resolve spontaneously or as a result of treatment(clinical manifestation)

(2)An exaggerated bronchoconstrictor response to stimuli that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness (Pathophysiologically)(3) Inflammation of the airways as defined by a variety of criteria (Pathogenesis)


Constriction of airway smooth muscle

Airway epithelium thickening

Mucus plugging

Lung Hyperinflation in Asthma

Thickbronchi with Mucous plugs

Mucous plug in asthma

Asthma - Microscopically

  • Patchy necrosis of epithelium

  • Sub-mucosal glandularhyperplasia

  • Hypertrophy of bronchial smoothmuscle

  • Eosinophils,mastcells,lymphocytes (Th2) infiltration

Asthma Microscopic Pathology






Asthma Pathogenetic Types

  • Extrinsic (Allergic/Immune)

    • Atopic - IgE

    • Occupational - IgG

    • Allergic Bronchopulmonary Aspergillosis - IgE

  • Intrinsic (Non-immune)

    • Aspirin induced

    • Infection induced

  • Predisposing Factors

  • Atopy

  • Causal Factors

  • Indoor Allergens

    • Domestic mites

    • Animal Allergens

    • Cockroach Allergens

    • Fungi

  • Outdoor Allergens

    • Pollens

    • Fungi

  • Occupational Sensitizers

  • Contributing Factors

  • Respiratory infections

  • Small size at birth

  • Diet

  • Air pollution

    • Outdoor pollutants

    • Indoor pollutants

  • Smoking

    • Passive Smoking

    • Active Smoking

Risk Factors that Lead to Asthma Development

Airflow Limitation


Cough Wheeze





InducersAllergens,Chemical sensitisers,Air pollutants, Virus infections



Allergens, Exercise,

Cold Air, SO2Particulates


  • History and patterns of symptoms

  • Physical examination

  • Measurements of lung function


  • Has the patient had an attack or recurrent episodes of wheezing?

  • Does the patient have a troublesome cough, worse particularly at night, or on awakening?

  • Does the patient cough after physical activity (e.g playing)?

  • Does the patient have breathing problems during a particular season (or change of season)?

  • Do the patient’s colds ‘go to the chest’ or take more than 10 days to resolve?

  • Does the patient use any medication (e.g. bronchodilator) when symptoms occur? Is there a response?

    If the patient answers “YES” to any of the above questions, suspect asthma

Physical Examination

  • Wheeze -Usually heard without a


  • Dyspnoea

  • Rhonchi heard with a stethoscope

  • Use of accessory muscles

    Remember -

    Absence of symptoms at the time of examination does not exclude the diagnosis of asthma

Blood Finding

  • Blood eosinophilia, elevated serum level of sIgE

  • Arterial blood gases:

    PaO2 between 55 and 70mmHg

    PaCO2 between 25 and 35mmHg

Radiographic finding

In severe asthma, hyperinflation, pneumomediastinum or pneumothorax may be detected


Sinus tachycardia (usually), right axis deviation, right bundle branch block, “P pulmonale”, ST-T wave abnormalities (severe asthma)

Diagnostic testing

Diagnosis of asthma can be confirmed by demonstrating the presence of reversible and variable airway obstruction using Peak Flow Meter

  • Bronchial challenge test: PC20<8mg/mL

  • Reversibility test: FEV1 increase more than 12% after inhalation of salbutamol, the absolute value of increase >200ml

  • Variability of PEF diurnally ≥20%

Differential diagnosis

  • Chronic bronchitis

  • Heart failure (“cardiac asthma”)

  • Hypersensitivity pneumonia

  • Lung cancer

Goals to Be Achieved in Asthma Control

  • Achieve and maintain control of symptoms

  • Prevent asthma episodes or attacks

  • Minimal use of reliever medication

  • No emergency visits to doctors or hospitals

  • Maintain normal activity levels, including exercise

  • Maintain pulmonary function as close to normal as possible

  • Minimal (or no) adverse effects from medicine

Tool Kit for Achieving Management Goals

  • Relievers

  • Preventers

  • Peak flow meter

  • Patient education

What Are Relievers? (also known as rescue medication)

  • Bronchodilator (beta2 agonist)

  • Quick relief of symptoms (within 2-3 minutes)

  • Used during acute attacks

  • Action lasts 4-6 hrs

  • Not for regular use


  • Short acting 2 agonists

    Salbutamol (万托林)

  • Anti-cholinergics

    Ipratropium bromide(爱全乐)

  • Xanthines


  • Adrenaline injections

What are Preventers?

  • Anti-inflammatory

  • Takes time to act (1-3 hours)

  • Long-term effect (12-24 hours)

  • Only for regular use

    (whether well or not well)

  • Prevent future attacks

  • Long term control of asthma

  • Prevent airway remodeling



Prednisolone, BetamethasoneMontelukast, Zafirlukast

Beclomethasone, Budesonide


Theophylline SR

Long acting 2 agonistsMast cell stabilisers

Bambuterol, SalmeterolSodium cromoglycate





Patient Education in the Clinic

  • Explain nature of the disease (i.e. inflammation)

  • Explain action of prescribed drugs

  • Stress need for regular, long-term therapy

  • Allay fears and concerns

  • Peak flow reading

  • Treatment diary / booklet

Status Asthmatic

  • FEV1 < 40%pred with treatment, PaCO2 increases, developing major complication such as pneumothorax

  • Close monitoring

  • Frequent treatments with inhaled β2-agonists, intravenous aminophylline, high-dose intravenous steroid

  • Oxygen supplement

  • Antibiotics – if infection exist

  • If indicated, intubation of the trachea and

    mechanical ventilation

The Pregnant Asthmatic

  • No departure from the ordinary management of asthma

  • No unnecessary medication should be administered

  • Systemic steroid should be used sparingly

  • Tetracycline, atropine, terbutaline(博利康尼?), iodine-containing mucolytics should be avoided

Key Messages

  • Asthma is a common disorder

  • It produces recurrent attacks of cough with or without wheeze

  • Between attacks people with asthma lead normal lives as anyone else

  • In most cases there is some history of allergy in the family

  • Asthma can be effectively controlled, although it cannot be cured

  • Effective asthma management programs include education, objective measures of lung function, environmental control, and pharmacologic therapy

  • A stepwise approach to pharmacologic therapy is recommended. The aim is to accomplish the goals of therapy with the least possible medication

Thank you!

  • Login