Asthma Treatment & Management Guidelines, Symptoms, Classification, Types, Medicine Lecture USMLE
Summary
TLDRThis video lecture discusses asthma, a chronic respiratory condition marked by reversible airflow obstruction and bronchial inflammation. It covers the triggers, clinical presentation, and diagnosis using pulmonary function tests. The script also explains the classification of asthma and its step-by-step treatment, including the use of inhalers and bronchodilators. Additionally, it addresses general measures, follow-up, and side effects of medications.
Takeaways
- 🌪️ Asthma is a chronic inflammatory disease of the respiratory system characterized by reversible air flow obstruction, bronchial hyper responsiveness, and inflammation.
- 🌿 Extrinsic asthma is allergic in nature, often triggered by allergens like pollens, dust mites, and pet dander, while intrinsic asthma is non-allergic and can be triggered by viral infections or cold air.
- 🚫 Certain medications like beta blockers and NSAIDs can induce asthma symptoms due to their effects on bronchoconstriction.
- 👶 Children exposed to second-hand smoke are at an increased risk of developing asthma.
- 🔊 Clinical presentation of asthma includes symptoms like persistent dry cough, shortness of breath, and chest tightness, with wheezing heard upon auscultation.
- 📈 Spirometry, a type of pulmonary function test, is crucial for diagnosing asthma by measuring forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).
- 🌡 Bronchial provocation tests, though not commonly performed, can provoke bronchoconstriction to confirm asthma diagnosis in patients with normal spirometry results.
- 💊 Treatment for asthma includes short-acting beta agonists (SABA) for rescue and inhaled corticosteroids (ICS) combined with long-acting beta agonists (LABA) for maintenance.
- 📉 Asthma is classified into intermittent, mild persistent, moderate persistent, and severe persistent based on symptom frequency and severity.
- 💉 Oral corticosteroids are reserved for severe persistent asthma that is not controlled with inhaler therapy due to their significant side effects.
- 🛑 Smoking cessation is critical for asthma patients as it can exacerbate symptoms and is a primary preventive measure.
Q & A
What is asthma?
-Asthma is a chronic inflammatory disease of the respiratory system characterized by reversible air flow obstruction, bronchial hyper responsiveness, and bronchial inflammation.
What are the key features of asthma?
-The key features of asthma include airflow obstruction that is reversible, episodic, and accompanied by hyper responsiveness of bronchi and bronchioles, leading to constriction and inflammation.
How is asthma classified based on triggers?
-Asthma is divided into two categories based on triggers: extrinsic asthma, which is mainly allergic, and intrinsic asthma, which is non-allergic and often triggered by viral infections or cold air.
What are common triggers for extrinsic asthma?
-Common triggers for extrinsic asthma include allergens like pollens, dust mites, pets, and floor dust.
What is the prognosis for extrinsic asthma?
-Extrinsic asthma, also known as allergic asthma, generally has a good prognosis.
What are the clinical presentations of asthma?
-Clinical presentations of asthma include persistent dry cough, shortness of breath, chest tightness, and wheezing due to bronchiole constriction.
How is asthma diagnosed?
-Asthma is diagnosed through typical clinical features like dry cough, difficulty breathing, chest tightness, and wheezes, along with demonstration of reversible bronchoconstriction through tests like pulmonary function tests (PFTs) and spirometry.
What is the difference between COPD and asthma on spirometry?
-Both COPD and asthma can show a decrease in FEV1/FVC ratio on spirometry, but COPD patients usually have a baseline obstruction, whereas asthma patients may have normal spirometry results between attacks.
What is the significance of bronchodilator reversibility test?
-The bronchodilator reversibility test is used to differentiate between COPD and asthma. In asthma, there is typically a greater than 12% increase in forced expired volume in the first second (FEV1) after bronchodilator administration, whereas COPD patients show little to no improvement.
How is asthma classified according to the National Asthma Education and Prevention Program?
-According to the National Asthma Education and Prevention Program, asthma is classified into intermittent asthma and persistent asthma, with the latter further divided into mild persistent, moderate persistent, and severe persistent asthma based on symptom frequency and severity.
What is the treatment for intermittent asthma?
-Intermittent asthma is treated with short-acting beta-agonist (SABA) inhalers as needed for relief, with daily therapy not typically required. However, the 2020 GINA guidelines recommend considering the addition of low-dose inhaled corticosteroids for daily therapy.
What are the potential side effects of inhaled corticosteroids used in asthma treatment?
-Potential side effects of inhaled corticosteroids include oral candidiasis, which is why patients are advised to rinse their mouth after use. Other side effects of systemic corticosteroids include diabetes mellitus, cataracts, osteoporosis, and adrenal suppression.
Outlines
🌬️ Understanding Asthma
The script begins by explaining asthma as a chronic inflammatory disease of the respiratory system. It highlights the features of asthma, including reversible air flow obstruction, bronchial hyper-responsiveness, and inflammation. The triggers for asthma are discussed, dividing asthma into extrinsic (allergic) and intrinsic (non-allergic) types. Extrinsic asthma is often linked to allergies to pollens, dust mites, and pets, while intrinsic asthma can be triggered by viral infections and cold air. The script also touches on how certain medications, like beta blockers and NSAIDs, can induce asthma symptoms. The importance of family history and exposure to second-hand smoke in the development of asthma is also mentioned.
🔍 Clinical Presentation and Diagnosis
This section delves into the clinical presentation of asthma, such as persistent dry cough, shortness of breath, and chest tightness. It explains the physical signs of asthma, like wheezing and hyper resonance in the lungs. The diagnosis process is outlined, emphasizing the use of pulmonary function tests (PFTs), particularly spirometry, to measure forced expiratory volume in one second (FEV1) and the FEV1/FVC ratio. The script also discusses how asthma can present differently, with some patients having normal lung function tests outside of an attack. Bronchial provocation tests are mentioned as a method to provoke bronchoconstriction for diagnostic purposes, although they are not commonly performed due to risks associated with severe asthma.
🏥 Differentiating Asthma from COPD
The script addresses how to differentiate asthma from COPD on spirometry results, noting that both conditions can show a decreased FEV1/FVC ratio. It points out that COPD patients typically have a baseline obstruction, whereas asthma patients may have normal lung function between attacks. The use of bronchodilator reversibility tests is introduced as a method to distinguish between the two, where a significant increase in FEV1 after bronchodilator use suggests asthma. The classification of asthma by the National Asthma Education and Prevention Program is also covered, outlining intermittent, mild persistent, moderate persistent, and severe persistent asthma.
💊 Treatment Approaches for Asthma
This part of the script discusses the treatment of asthma, starting with intermittent asthma and moving through mild, moderate, and severe persistent asthma. It details the use of short-acting beta-agonists (SABA) like albuterol for rescue therapy and the addition of low-dose inhaled corticosteroids for daily therapy in mild persistent asthma. For moderate and severe persistent asthma, the script describes the use of long-acting beta-agonists (LABA) in combination with inhaled corticosteroids, leukotriene receptor antagonists, and long-acting muscarinic antagonists. The importance of patient compliance, proper inhaler technique, and the use of spacers is emphasized. The script also cautions about the side effects of medications used in asthma treatment.
📈 Managing and Monitoring Asthma
The final section focuses on the management and monitoring of asthma. It stresses the importance of medication review, avoiding allergens, treating comorbidities, and smoking cessation. The use of peak flow meters for patients to monitor their lung function at home is introduced. The script also discusses the importance of follow-up visits to assess symptom frequency and lung function, and the possibility of step-down therapy if the patient is stable. It addresses the inadequate response to treatment, the need for compliance checks, and the proper use of inhalers. The side effects of inhaled corticosteroids and oral corticosteroids are mentioned, along with historical notes on the use of grimald cigarettes, which contained atropine and cannabis, as a treatment for asthma in the past.
Mindmap
Keywords
💡Asthma
💡Reversible Airflow Obstruction
💡Bronchial Hyper-responsiveness
💡Extrinsic Asthma
💡Intrinsic Asthma
💡Pulmonary Function Tests (PFTs)
💡Spirometry
💡Bronchodilator
💡Inhaled Corticosteroids
💡Status Asthmaticus
💡Peak Flow Meter
Highlights
Asthma is a chronic inflammatory disease of the respiratory system characterized by reversible air flow obstruction.
Asthma is divided into extrinsic (allergic) and intrinsic (non-allergic) categories based on triggers.
Extrinsic asthma often has a good prognosis and is associated with a family history of atopy.
Intrinsic asthma can be triggered by viral infections and is often linked to GERD.
Children exposed to second-hand smoke have an increased risk of developing asthma.
Asthma symptoms include persistent dry cough, shortness of breath, and chest tightness.
Pulmonary function tests, specifically spirometry, are crucial for diagnosing asthma.
Asthma diagnosis can be confirmed with a decrease in FEV1/FVC ratio on spirometry.
Bronchial provocation tests can be used to diagnose asthma in patients with normal spirometry results.
Asthma is classified into intermittent, mild persistent, moderate persistent, and severe persistent categories.
Intermittent asthma is characterized by symptoms less than twice a week and no daily activity limitations.
Mild persistent asthma is treated with low-dose inhaled corticosteroids and short-acting beta-agonists.
Moderate persistent asthma requires a combination of inhaled corticosteroids and long-acting beta-agonists.
Severe persistent asthma may necessitate the addition of oral corticosteroids to inhaled therapies.
General measures for asthma patients include medication review, allergen avoidance, and smoking cessation.
Teaching patients the use of peak flow meters can help monitor asthma symptoms at home.
Inhaled corticosteroids can cause oral candidiasis, and patients should rinse their mouths after use.
An interesting historical note is that Grimald cigarettes, containing atropine and cannabis, were once prescribed for asthma.
Transcripts
okay in our video series of pulmonology
lectures in this video we are going to
talk about asthma we are going to
discuss the presentation and diagnosis
of asthma we are going to discuss it how
do you treat a patient of asthma step by
step first of all asthma is a chronic
inflammatory disease of respiratory
system characterized by reversible air
flow obstruction
and bronchial hyper responsiveness and
bronchial inflammation so there are
three main important things that there
is airflow obstruction blood that
airflow obstruction is reversible that
airflow obstruction is episodic and
there is hyper responsiveness of bronchi
and bronchioles so the bronchioles
constrict and there is inflammation of
the bronchioles this is a picture
showing normal bronchioles look at the
normal dilated bronchioles and this is
the picture showing bronchioles in
asthma where they are constricted they
are red they are inflamed and that
happens episodically that is reversible
now coming to the triggers of asthma on
the basis of the triggers of asthma
asthma is divided into two categories
extrinsic and intrinsic asthma extrinsic
asthma is mainly the allergic asthma and
patients are allergic to pollens dust
mites pets floor dust patients whenever
they are exposed to these things they
develop bronchial constriction they
develop inflammation of the bronchi they
get difficulty in breathing they develop
visas in their chest they're allergic to
these things these are the people who
also have a history of atop these people
have members in their family who are
also allergic to many things they have a
family history of etopy and remember
extrinsic asthma allergic asthma has a
good prognosis
the other category includes intrinsic
asthma in intrinsic asthma it is
non-allergic
and most common cause of non-allergic
asthma is viral infection especially in
the children cold air can induce known
allergic or intrinsic asthma exposure to
cold air causes constriction of the
bronchiole inflammation and resulting in
asthma
these patients usually have Gerd asthma
patients are three times more likely to
develop gerd because this acid reflux it
irritates the bronchial Airways when it
irritates the bronchial Airway it causes
constriction
medications like beta blockers NSAIDs
can also cause asthma beta blockers
block The beta2 receptors and they cause
bronchoconstriction that's why we use
beta agonists for the treatment NSAIDs
can also cause bronchoconstriction
NSAIDs cause increase in leukotriene
levels which cause bronchoconstriction
so this is extrinsic asthma which is
allergic intrinsic eczema which is
non-allergic an important point to
remember is that children who have
exposure to second-hand smoke have
increased risk of developing asthma
now coming to the clinical presentation
of asthma whenever a patient with asthma
is exposed to these agents that
triggered asthma they develop persistent
dry cough they develop shortness of
breath they develop chest tightness
because the bronchioles have now
constricted when the bronchioles have
constricted it's difficult for the air
to get out of the lungs it is an
obstructive disease therefore you will
listen to and expiratory weasels there
will be visas at the end of expression
because it is difficult for the air to
get out of the lungs and when it is
difficult for the air to get out of the
lungs air will accumulate in there and
there will be hyper resonance the lungs
will be hyper resonant now this is how
the VZ chest sounds like whenever you
put stethoscope on the chest of a person
who is suffering from asthmatic attack
this is how the chest sounds like
this is not how a normal chest sounds
like these are the whises that are
present in the chest you can put the
stethoscope on your own chest and listen
to the normal breath sounds and then
compare it with this audio these are all
the Visas because it is difficult for
the air to get out of the lungs now
coming to the diagnosis of asthma in the
diagnosis of asthma if the patient's age
is greater than or equal to five years
of age if the patient has typical
clinical features of asthma dry cough
difficulty breathing chest tightness
wheezes and with that there is
demonstration of reversible
bronchoconstriction how do you do that
you do that with tests like pfts
pulmonary function tests are the main
tests for diagnosis of asthma in
pulmonary function test there is a test
called a spirometry in spirometry what
you do is that you ask the patient to
take a full breath and then exhale
through mouth into this device this
device is a part of spirometer and that
spirometer detects that how much a
person can exhale and with which speed
they can exhale now if the patient is
having asthma that patient would not be
able to Exhale air out easily because
there is obstruction because there is
bronchoconstriction so the forced
expiratory volume in the first second it
detects the force expiratory volume in
the first second and that volume of air
that that patient exhales will be less
than a normal person and we also
calculate the ratio of force expiratory
volume 1 with forced vital capacity the
capacity of air that a person can
normally exhale is called as forced
vital capacity and that ratio is also
decreased
so a normal person can exhale air easily
without any difficulty but a patient
with asthma has to Exhale the air out
with difficulty due to the
bronchoconstriction therefore fev1 will
be less now sometime it happens that a
patient comes to you and tells you the
doctor I get difficulty breathing
sometime I get chest tightness I
sometimes experience dry cough
difficulty breathing but when you
examine the patient patient at that
point in time is totally normal
why this is because that as I said that
asthma is a reversible disease sometimes
the patient is in a very bad condition
patient is experiencing just tightness
difficulty breathing but after some time
the patient is totally fine all the
tests are normal the examination is
normal there are no findings because it
is a reversible disease so patient has a
normal Baseline Health but sometimes he
experiences bronchoconstriction and
exacerbation of asthma now that patient
is having a total normal examination if
you go for fev1 FEC at that time when
the patient is not having an anasma
attack the patient's fev1 will be normal
the feb1 FEC ratio will also be normal
in that case if you are suspecting that
that patient has asthma then bronchial
provocation tests are done
bronchial provocation tests are the
tests that provoke the
bronchoconstriction
they give certain agents like
methylcholine
that methacholine is given in a
concentration that if it is given to a
normal person normal person would not
experience that much bronchoconstriction
but if it is given to an asthmatic
patient asthmatic patient would cause
severe bronchoconstriction and you will
detect that on spirometry you repeat
spirometry after given giving
methylcholine and you detect a decrease
in fev1 and fvc
but remember that these tests are also
risky if a patient is a severe asthmatic
patient and the spirometry came out to
be normal and you plan to go for
bronchial provocation test sometimes
there is a risk that that patient can
develop status asthmaticus now in real
life these bronchial provocation tests
are not as commonly performed because
sometimes the patient are having severe
asthma and they are coming to you in a
state where they are totally fine they
are totally normal but to diagnose you
give methylcholine and it causes severe
bronchoconstriction anyone state of
systematicus so methylcholine challenges
just for remember them for academic
purposes but in real life these tests
are not commonly performed what you can
do is that you can ask the patient to do
some exercise if the spirometer is
totally normal you can ask the patient
to do some exercise and if there is some
cold air some cold temperature in that
cold air if the patient does some
exercise then there can be slight
bronchoconstriction and you can see a
decrease in the levels of spirometry
so if a patient comes to you with an
estimatic attack you can do spirometry
in that case the spirometry will show
decrease in fev1 to FCC ratio but if the
patient is not experiencing as estimatic
attack at that point when it comes to
you in your clinic
then bronchial provocation tests can be
done which are not commonly performed
and if they were performed then the a
decrease in fev1 by 20 percent is
diagnostic for asthma so in the
diagnosis typical clinical features with
demonstration of reversible
bronchoconstriction on pfts bronchial
provocation test as a second line test
this is how you make the diagnosis of
asthma now there is one another point
that I want to mention here that when
you receive a patient with an asymmetic
attack and you perform spirometry and
the spirometry shows results like this
decrease fev1 to fvc ratio in such case
COPD patients also have the same pattern
on spirometry now how will you
differentiate that whether it is COPD or
it is asthma one important thing in the
clinical history would be that COPD
always have a baseline disease COPD
patients usually have a baseline disease
Baseline obstruction all the time and in
between they get the exacerbations in
asthma patients will say that I was
totally
Leaf of the days but sometimes I so
we're just tightness and difficulty
breathing so that is one important Point
other than that for academic purposes
you can also remember that there is a
bronchodilator reversibility test now if
the patient is having a difficulty
shortness of breath chest tightness you
do you suspect that that patient is
having asthma you perform spirometer you
get results like this then what you can
do is that you can give bronchodilator
challenge you can give bronchodilator to
the patient like albuterol 200 to 400
microgram now when you give Alberta role
to the patient that albuterol will cause
bronchodilation and that bronchodilation
will make it easier for a patient for a
stomatic patient to breathe to Exhale
the air out
so when you perform the spirometry now
after giving the bronchodilator they
will be greater than 12 percent
increased in the forced expired volume
in the first second
but in COPD patient there will not be as
much change there will be no improvement
even after giving bronchodilators
so if you are confused at whether that
patient is having COPD or asthma in that
case you can perform bronchodilator
reversibility test so a patient comes to
you in your clinic with chest tightness
with shortness of breath you suspect
asthma you perform spirometry if the
spirometry it shows decrease ref1 FEC
and you suspect that that patient is
having asthma or COPD you can perform
bronchodilator reversibility now coming
to the classification of s my according
to the National asthma education and
prevention program the classes of asthma
include intermittent asthma persistent
asthma persistent asthma is further
divided into three categories mild
persistent moderate persistent and
severe persistent asthma
now we'll discuss each one of them in
detail the how are they classified on
the basis of their symptoms and their
treatment with each category first
coming to the intermittent asthma a
patient is said to have intermittent
asthma if the patient experiences
symptoms of bronchoconstriction asthma
frequency less than two times a week
waking up because of symptoms at night
less than two times are equal to two
times a month use of short acting beta
Agonist drugs short technique beta
Agonist drugs are the drugs that are
present in the inhalers that cause
bronchodilation less than or equal to
two days per week so you can remember
the word two these classes are basically
categorized based on the symptoms with
which the patient presents so if the
symptoms are slightly Mild they are
classified into intermittent asthma and
when you perform spirometry on these
patients the force expiratory volume is
greater than or equal to 80 percent of
the expected which is a normal value
so these patients are not having that
severe asthma that their fev1 is
deranged but they develop the shortness
of breath they develop difficulty
breathing sometimes
exacerbation requiring steroids less
than one time a year
now how do you treat these patients with
intermittent asthma these intermittent
asthma patients are treated with just
Saba inhaler short acting beta Agonist
inhalers these beta Agonist drugs are
contained in these containers and they
cause bronchodilation drugs like
albuterol are short acting beta agonists
inhaled albuterol 90 microgram per puff
now what you do is that you ask the
patient that whenever you feel chest
tightness whenever you feel shortness of
breath what you do is that you take the
inhaler you shake the inhaler first and
then you exhale the air out then you
hold it around your mouth tightly and
you inhale through your mouth at the
same time press the inhaler
and then you should stop breathing for
at least 10 seconds you should hold the
breath for 10 seconds and after 10
seconds you can exhale through your
mouth
so that there is effective drug
absorption within the lungs two to four
Puffs as needed whenever the patient has
anastomatic attack daily therapy is not
required it is just a rescue inhaler
rescue inhaler means that whenever
patient feels an attack of asthma
whenever patient feels that he is having
shortness of breath at that time patient
will use this inhaler daily therapy is
not recommended in patients with
intermittent asthma they will just have
to use these rescue inhalers only
whenever they feel chest tightness
difficulty in breathing whenever they
feel they are having asthmatic attack
they just use these rescue inhalers
otherwise no drilling inhalers no daily
use drugs are prescribed 2020 Gina
guidelines recommended to add low dose
inhaled corticosterides for daily
therapy now coming to persistent asthma
persistent asthma is further divided
into three categories mild persistent
moderate persistent severe persistent
we'll discuss that how are they
classified then we'll discuss the
treatment of each one of these mild
persistent if the patient is having
symptoms greater than two times a week
waking up at night three to four times
per month with minor limitation of daily
activities
moderate persistent asthma is the one
when the patient is having symptoms of
asthma daily waking up for greater than
one time a week
some limitation of activity of daily
life in severe persistent asthma patient
will be having daily symptoms throughout
the day it's a severe form of asthma
waking up every night because of
difficulty in breathing and there is
Extreme limitation of activity that
patient cannot exercise that patient
cannot perform the daily life activity
because he is I mean getting severe
attack of asthma again and again now
when you perform spirometry on these
patients what you would see is that the
spirometry results will be normal in
mild persistent asthma and feb1 will be
greater than 80 percent whenever the
fev1 is greater than 80 percent of the
predictive value it's normal but when it
is less than 80 it's abnormal in
moderate persistent it's from 60 to 80
percent of the predicted in the severe
persistent it will be even less than 60
percent which is a severe form of asthma
now coming to treatment of each one of
these in the treatment of mild
persistent asthma you give the daily
therapy in intermittent asthma daily
therapy was not recommended only Gina
guidelines recommended that you can add
low dose inhered corticosteroids in mild
persistent asthma daily therapy is
recommended with low dose inhaled
corticosteroids in helicorticosteroids
include productionide fluticasone
other Alternatives that can be used for
daily therapy include leukotriene
receptor antagonist as I said that
leucotrans cause bronchoconstriction so
we antagonize them with leukotriene
receptor antagonists like Montelukast
zaphast these are leukotriene receptor
antagonists and they can be prescribed
to patients as for daily therapy in mild
persistent asthma and whenever the
patient gets attack you ask the patient
to use the short acting beta Agonist
albuterol inhaler as I showed you in the
previous picture so whenever it gets
patient gets the attack patient uses
sub-inl otherwise daily patient is using
inhale corticosteroid inhaler as a daily
therapy now coming to the moderate
persistent asthma and the treatment of
moderate persistent asthma it is a more
severe form of asthma and in which you
have to give daily therapy with inhalers
that contain ludos inhaled
corticosteroid and for metrol for mitral
is basically long acting bit Agonist now
remember one thing that short acting
beta Agonist inhalers can be given alone
but long-acting beta Agonist inhalers
can never be given alone they are given
which steroids combination
so for Mid role is given with a
combination of inhaled corticosteroid
preferably a single inhaler and that
patient uses that single inhaler as a
daily therapy as well as as a rescue
therapy whenever patient gets attack
patient uses that in otherwise patient
also uses that in another daily
now remember as I said that there are
two important components in the
pathogenesis of asthma one is bronchial
inflammation and the other one is
bronchial constriction the inhibit
Agonist inhalers control the
bronchoconstriction they call
bronchodilation
and the steroids they reduce the
inflammation so you we are treating the
both components of asthma other
combinations include inhaled
corticosteroids with long-acting bit
agonists other than format role inhaled
corticosteroids in combination with long
acting muscarinic antagonists inhaled
corticosterides with leukotriene
receptor antagonists and you can add
Saba if you are using the last two
otherwise if you are giving inhaled
corticosteroid with four meter roll
inhaler in a single inhaler you can give
it as a daily therapy as well as a
rescue therapy you did not need to add
Sabah into this
now coming to severe persistent asthma
so we are persistent as much as a severe
form of asthma and in this condition you
need to give inhaled corticosteroids
with long-acting beta Agonist and long
acting muscarinic antagonists inhaled
corticosteroids include buddhistonide
and proticason long-acting beta agonists
include format role and long-acting
muscarinic antagonists muscarinic
antagonists are the drugs that block the
action of parasympathetics some
parasympathetic system causes
bronchoconstriction and if you are
blocking the parasympathetic system
which results in bronchodilation and
they include diode propion bromide
and with this combination you give
rescue inhaler Saba whenever the patient
gets attacked patient uses saba and as a
daily therapy patient uses these drugs
if the patient's asthma is still not
controlled what you need to do is that
you can add oral corticosteroids now we
were avoiding oral corticosteroids
throughout but in severe persistent
asthma which is not controlled with the
inhale drug you need to add oral
corticosteroids because in severe
persistent asthma there is severe
inflammation there is a severe
disability of the patient who cannot
perform the real life activities every
night patient is waking up with an
asymmetic attack you need to add oral
corticosters if it is not controlled
with inhale drugs with that you need to
give inhaled corticosteroids and long
acting beta Agonist
now coming to some general Myers in a
patient who is being treated for asthma
what you need to do is that you need to
do medication review if the patient is
taking beta blockers remember beta
blockers are contraindicated in patients
with asthma if you are ever prescribing
beta blockers to a patient you must ask
any history of asthma if the patient is
having any history of asthma then beta
blockers are contraindicated other than
that NSAIDs as I said that NSAIDs
increase leukotrans and leucotrans cause
bronchoconstriction you ask the patient
to avoid allergen patients really knows
that which thing he is allergic to and
asks them to use impermeable pillow
covers bed sheets treat the comorbs and
if the patient is having good treated
with proton pump inhibitors smoking
cessation is most and highly important
very important for patients with asthma
and you teach the patient use of peak
flow meter this is a picture showing
Peak flow meter in which they exhale the
air and see how much air they are
exhaling out
whenever the patient has an asthma
attack they can exhale out less air and
they can see that by themselves at home
and when they take the inhaler they can
even see the improvement with Peak flow
meter so you teach the patients use of
peak flow meter and I have also made a
video on the treatment of strata
systematic as if a patient gets severe
status asthematicus attack how do you
manage it I have talked about it in
detail in my video on status
systematicus management you can check
out the link in the description below
now in the follow-up when you have
started the therapy you ask the patient
to come back in two or four weeks and
you check the symptom frequency that by
the symptom frequency has decreased or
not you see that whether is the patient
has decreased frequency of developing
excess abations and you do pfts and if
the patient is improving then after some
stable period you can consider step down
therapy now in some patients who are
again and again coming to you and they
are not getting better with the
treatment even with the Step Up therapy
when you are adding more drugs the
patients are not getting better now
whenever you are going for a step up
therapy when you are going to add a drug
remember to see that whether that
patient is compliant with the treatment
or not and also assists the inhaler
technique many patients do not even know
that how to use inhaler and they are
technically wasting drug they are not
even using that inhaler properly teach
them to use inhaler properly and if they
cannot use the inhaler properly ask them
to use spacer this is a picture of
spacer spacer is a device that is
attached with the inhaler and patient
inhales the drug from this part now the
good thing about spacer is that if the
patient misses the drug in one breath
the drug is not wasted the drug is
present in the inhaler and that patient
can in inhale it in second or third
breath now briefly coming to the side
effects of the drugs used in treatment
of asthma inhaled corticosterides the
inhalers that contain corticosteroids
cause oral candidiasis remember as a
patient that whenever they use inhaler
that contain corticosterite they must
rinse their mouth with water
short-acting beta Agonist most commonly
cause slight tremor
oral corticosteroids can cause diabetes
mellitus cataract osteoporosis adrenal
suppression of steroids therefore we
reserve the oral corticosteroids for
very severe asthma if the very end we
give it to the patients an interesting
tidbit in the past grimald cigarettes
were prescribed to the patients with
asthma these grimald cigarettes used to
contain atropine in it atropine is an
anticholinergic which causes
bronchodilation other than that they
used to contain cannabis in it the Tura
in it so they were this is an ad that is
recommending used for of grimald
cigarettes for asthma bronchial trouble
hey fever and laryngitis but now after
all this research we know how much the
tobacco is dangerous for a patient with
asthma smoking cessation is most
important thing for a patient with
asthma the first best intervention that
you can do is in an asthma patient is to
tell them to stop smoking cigarettes
this is just an interesting fact from
the past
in summary we talked about what is
asthma the triggers of asthma the
symptoms the diagnosis with pfts the
classification the intermittent asthma
and the treatment of intermittent asthma
moderate mild persistent moderate
persistence severe persistent asthma and
their treatments the general Meyers the
follow-up causes of inadequate response
side effects of the drugs used for
asthma if you liked my video please
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