Canadian Medical Care
Bronchial Asthma is a clinical syndrome characterized by episodic reversible airway obstruction, increased bronchial reactivity and airway inflammation.
The common symptoms are:
- Chest tightness
- Shortness of breath
Asthma can be divided into:
- Extrinsic – external cause
- Intrinsic – no causative agent can be identified
Extrinsic Asthma – occurs most frequently in atopic individuals who show positive skin tests to inhalant allergens. Positive skin tests to inhalant allergen are shown in 90% of children with asthma; where as, only 50% of adults show this phenomenon. Eczema is often seen in childhood.
Intrinsic Asthma – often starts in middle age. However this classification is of little value in clinical practice. Non – atopic individuals may develop asthma in middle age from extrinsic causes such as sensitization to occupational agents or aspirin intolerance.
Sex – in children, boys have been sown to be at greater risk for asthma than girls. In children, younger than fourteen years, the prevalence is twice as high in boys compared to girls.
Age – disease onset can occur in persons of any age, but children often present when younger than six years. Many children out grow asthma, especially boys who have no personal or family history of atopy.
Causes of asthma- Triggers of asthma
- Environmental exposure to allergen. e.g. Seasonal pollen, early spring from trees, late spring and summer from grass, mould spores,dust mites,animal allergen and some foods specially in children.
- viral infection e.g rhinovirus
- cold air and exercise
- irritant dusts ,vapour and fumes ,cigarette smoke
- occupational sensitisers
- Atmospheric pollution ,diesel exhaust.
- Drugs e.g. NSAID´S and B-adrenoceptor blocking agents .
- hormonal changes e.g pregnancy , menstrual cycle
- pulmonary function tests
- peak flow charts : measurement of PEFR on waking ,in the middle of the day and before bed are particularly useful in demonstrating the variable airflow limitation that characterizes the disease
- Chest x-ray
- Skin tests : skin prick tests should be performed in all cases of asthma to identify extrinsic causes
1. Control of extrinsic factors : Measures must be taken to avoid causative allergens such as the house-dust mite,pets,moulds and certain food stuff.Pollen avoidance is impossible ,however contact may be diminished by wearing sunglasses. Avoiding walks in the countryside particularly in the late afternoon when the number of pollen grains is highest at ground level.Keeping the bedroom window shut at night also helps. Avoidance of the house-dust mite is now possible with effective and comfortable covers for bedding and changes to living acccomodation.Active and passive smoking should be avoided .
2. Drug Treatment :The mainstay of asthma therapy is the use of therapeutic agents delivered as aerosols or powders directly into the lungs. Following drugs are used in the management:
- B Adrenoceptor agonists : Inhalants such as Salbutamol 50-100ug or Terbutaline250-ugshould be prescribed as two puffs as required. . Salmeterol 50-100ug is also very potent and effective
- Anticholinergic bronchodilators : Ipratropium bromide 20 -40mg 3 to 4 times a day by aerosol is very effective bronchodilator.
- Anti -inflammatory drugs:e.g sodium cromoglycate.
- Inhaled Corticosteroids: Beclomethasone dipropionate in doses of 50, 100 and 250 ug per puff. Budesonide in doses of 200ug per puff.and Fluticasone propionate 50,100 and 250 ug per inhalation and is twice as potent as beclomethasone
Management of acute, severe asthma
- Assess the patient , if heart rate and respiratory rate high and also inability to speak in sentences indicate a severe attack.
- Nebulized salbutamol 5 mg is administered
- Hydrocortisone sodium succinate 200mg i.v given
- O2 40-60 % is given
- Prednisolone 60 mg is given orally
- If no improvement is seen ,intravenous infusion of Salbutamol 3-20 ug or aminophlline infusion 750mg/24hrs is given
- Arterial blood gasses are measured ,if the PaCo2 is greater than 7 kpa,ventilation should be considered
The Canadian medical center offers both acute and chronic management of asthma.All investigations including spirometry and skin allergic tests are done by specialized medical staff. Senior pulmonologist has clinic twice a week in the center to see the special cases .All the important medication including inhalaers are available in the pharmacy of the center.
This Article was provided by Canadian Medical Care
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