Asthma Treatment & Management Guidelines, Symptoms, Classification, Types, Medicine Lecture USMLE

Summary

This 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.