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ROHAYAH ABDULLAH
FAMILY MEDICINE SPECIALIST
POLIKLINIK KESIHATAN KOTA TINGGI
EPIDEMIOLOGY
Asthma is a common disease with
unacceptable high morbidity and
mortality
Prevalence is increasing worldwide
It is commonly under diagnosed and
undertreated
Many deaths and morbidity have been
a/w inadequate treatment, under-use of
objective measurement of severity and
inadequate supervision
PREVALENCE OF ASTHMA IN
MALAYSIA
Primary school children: 13.8%
Children aged 13-14 years: 9.6%
Adult (self-reported) in NHMS:
4.1%
Prevalence was higher in rural
(4.5%) than in Urban areas (4.0%)
Prevalence was also higher in
those with lower educational
status (5.6%) and lower income
(4.7%)
DEFINITION
Asthma, irrespective of severity, is a chronic
inflammatory disorder of the airways.
In susceptible individual, this inflammation
causes recurrent episodes of wheezing,
breathlessness, chest tightness and
cough particularly at night and in the early
morning
This episodes are usually a/w widespread but
variable airflow obstruction that is often
reversible either spontaneously or with
treatment.
HOW TO DIAGNOSE
ASTHMA?
DIAGNOSING ASTHMA
Wheezing
H/o any of the following:
4. Short-acting bronchodilators
Anti-inflammatory
medications
Reducing the inflammation will decrease
bronchial hyper-responsiveness
3 types:
i) Corticosteroids
- the main prophylactic drugs
ii) Cromones eg. Sodium cromoglycate
- It is effective in the symptomatic and
prophylactic management of mild
persistent asthma but less effective in
more severe asthma
i) Antileukotrienes e.g Montelukast
THAN CURE
ACUTE SEVERE ASTHMA
WHY DO PAITENTS DIE:
DISEASE FACTORS
PATIENTS BEHAVIOUR,PSYCHOSOCIAL
FACTORS
DISEASE FACTORS
CHRONIC SEVERE B.A.
HEAVY SEDATION
DENIAL
LEARNING DIFFICULTY
EMPLOYMENT PROBLEMS
INCOME PROBLEMS
SOCIAL ISOLATION
CHILDHOOD ABUSE
BRITTLE ASTHMA
HEALTH CARE PROFFESSIONALS
AFTER ADMISSION
AIMS OF MANAGMENT
TO PREVENT DEATH
TO RELIEVE SYMPTOMS
TO RESTORE PATIENTS LUNG
FUNCTION
TO THE BEST POSSIBLE LEVEL AS
SOON
AS POSSIBLE.
TO PREVENT EARLY RELAPSE
ASSESSMENT
NEED TO ASSESS SEVERITY RAPIDLY
GIVE APPROPRIATE TREATMENT
HISTORY
PHYSICAL EXAMINATION
PEFR MEASUREMENT
INITIAL ASSESSMENT
MILD ASTHMA:
PERSISTENT COUGH
INCREASED CHEST TIGHTNESS
NORMAL SPEECH
MODERATE WHEEZE
RESP. RATE>25/MIN
DETERIORATING PEF
PERSISTENT OR WORSENING HYPOXIA
HYPERCAPNIA
ABG:
EXHAUSTION FEEBLE RESPIRATION
DROWSINESS,CONFUSION
COMA, RESPIRATORYARREST
ASSESMENT OF RESPONSE
TO INITIAL TT.
SYMPTOMS
PHYSICAL FINDINGS
INCOMPLETE RESPONSE:
PERSISTENT SYMPTOMS & SIGNS
PEF50-75% OF BEST OR PREDICTED VALUE
RESPONSE TO INITIAL TT.
POOR RESPONSE:
PERSISTENT OR DETERIORATING
SYMPTOMS & SIGNS
PEF<50%
BEFORE DISCHARGE FROM
A&E
REVIEW ADEQUACY OF USUAL TT.
&STEP UP IF NECCESARY
ENSURE PT. HAS ENOUGH SUPPLY OF
MEDICATION
CHECK INHALER TECHNIQUE
FOLLOW UP WITHIN 2 WKS. OR EARLIER
ADVISE PT. TO RETURN IMMEDIATELY IF
ASTHMA WORSENS
MANAGEMENT IN THE WARD
CONTINUE O2 >40%
I.V HYDROCORTISONE 6 HRLY/ PREDNISOLONE
30-60MG DLY.
NEBULISED BETA AGONIST EVERY 15MIN--2-
4HRLYDEPENDING ON SEVERITY +
ANTICHOLINERGIC.
IF STILL NO IMPROVEMENT:
I.V. AMINOPHYLLINE>0.5-0.9MG/KG/HR. IF
CONTINUED FOR MORE THAN 24 HRS MONITOR
BLOOD LEVELS. ALTERNATIVE :
BETA AGONIST INFUSION 3-20mcg./MIN AFTER
SERUM ELECTROLYTES:
HYPOKALAEMIA IS A RECOGNISED
COMPLICATION
OF TT. WITH BETA AGONIST
&CORTICOSTEROIDS
E.C.G. IF INDICATED
REFERRAL TO INTENSIVE
CARE
ACUTE SEVERE OR LIFE THREATENING ASTHMA NOT
RESPONDING TO THERAPY , EVIDENCED BY:
DETERIORATING PEF
PERSISTENT OR WORSENING HYPOXIA
HYPERCAPNIA
ABG:
EXHAUSTION FEEBLE RESPIRATION
DROWSINESS,CONFUSION
COMA, RESPIRATORYARREST
DISCHARGE PLAN FOR
HOSPITALISED PT.
BEFORE DISCHARGE PT. SHOULD BE: