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1 To introduce 1 min INTRODUCTION Lecture cum LCD
the topic Ever hear the term "bronchial asthma" and demonstration
wonder what it means? When people talk about
bronchial asthma, they are really talking about
asthma, a chronic inflammatory disease of the
airways that causes periodic "attacks"
of coughing, wheezing, shortness of breath, and
chest tightness.

.Asthma affects more than 25 million people in

the U.S. currently. This total includes more than
5 million children. Asthma can be life-
threatening if you don’t get treatment.
2. To define
bronchial 1 min
DEFINITION
asthma Bronchial asthma (or asthma) is a lung disease.
Your airways get narrow and swollen and are
blocked by excess mucus. Medications can treat
these symptoms.
Asthma, also called bronchial asthma, is a
disease that affects your lungs. It’s a chronic
(ongoing) condition, meaning it doesn’t go
3. 2 away and needs ongoing medical management.
mins CAUSES
Bronchial Asthma Triggers
Bronchial asthma triggers may include:

 Smoking and secondhand smoke

 Infections such as colds, flu, or
pneumonia
 Allergens such as
food, pollen, mold, dust mites, and pet
dander
  Air pollution and toxins

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 Weather, especially extreme changes in Lecture cum LCD
temperature demonstration
 Drugs (such as aspirin, NSAIDs, and
beta-blockers)
 Food additives (such as MSG)
 Emotional stress and anxiety
 Singing, laughing, or crying
 Perfumes and fragrances
 Acid reflux
4. To enumerate 5
the symptoms mins Symptoms
Asthma symptoms vary from person to person.
You may have infrequent asthma attacks, have
symptoms only at certain times — such as
when exercising — or have symptoms all the
time.

Asthma signs and symptoms include:

 Shortness of breath

 Chest tightness or pain

 Wheezing when exhaling, which is a

common sign of asthma in children

 Trouble sleeping caused by shortness of

breath, coughing or wheezing

 Coughing or wheezing attacks that are

worsened by a respiratory virus, such as a
 cold or the flu

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Signs that your asthma is probably worsening
include:

 Asthma signs and symptoms that are

more frequent and bothersome

 Increasing difficulty breathing, as

measured with a device used to check
how well your lungs are working (peak
flow meter)

 The need to use a quick-relief inhaler Lecture cum LCD

demonstration
more often

For some people, asthma signs and symptoms

flare up in certain situations:

 Exercise-induced asthma, which may be

worse when the air is cold and dry

 Occupational asthma, triggered by
workplace irritants such as chemical
fumes, gases or dust

 Allergy-induced asthma, triggered by
airborne substances, such as pollen, mold
spores, cockroach waste, or particles of
skin and dried saliva shed by pets (pet
dander)
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5. To list out the 3 Risk factors
risk factors mins

A number of factors are thought to increase

your chances of developing asthma. They
include:

 Having a blood relative with asthma, such

as a parent or sibling

 Having another allergic condition, such as

Lecture cum LCD
atopic dermatitis — which causes red, demonstration
itchy skin — or hay fever — which
causes a runny nose, congestion and itchy
eyes

 Being overweight

 Being a smoker

 Exposure to secondhand smoke

 Exposure to exhaust fumes or other types

of pollution

 Exposure to occupational triggers, such as

chemicals used in farming, hairdressing
and manufacturing
 Complications

Asthma complications include:

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 A permanent narrowing of the tubes that
carry air to and from your lungs
(bronchial tubes), which affects how well
you can breathe

 Emergency room visits and

hospitalizations for severe asthma attacks

 Side effects from long-term use of some

medications used to stabilize severe
asthma
Lecture cum LCD
Proper treatment makes a big difference in demonstration
preventing both short-term and long-term
complications caused by asthma.
6. To explain the 2
prevention mins
Prevention

While there's no way to prevent asthma, you

and your doctor can design a step-by-step plan
for living with your condition and preventing
asthma attacks.

 Follow your asthma action plan. With

your doctor and health care team, write a
detailed plan for taking medications and
 managing an asthma attack. Then be sure
to follow your plan.

Asthma is an ongoing condition that

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needs regular monitoring and treatment. Taking
control of your treatment can make you feel
more in control of your life.

 Get vaccinated for influenza and

pneumonia. Staying current with
vaccinations can prevent flu and
pneumonia from triggering asthma flare-
ups.

 Identify and avoid asthma triggers. A

number of outdoor allergens and irritants Lecture cum LCD
demonstration
— ranging from pollen and mold to cold
air and air pollution — can trigger asthma
attacks. Find out what causes or worsens
your asthma, and take steps to avoid those
triggers.

 Monitor your breathing. You may learn

to recognize warning signs of an
impending attack, such as slight
coughing, wheezing or shortness of
breath.

But because your lung function may

decrease before you notice any signs or
symptoms, regularly measure and record
 your peak airflow with a home peak flow
meter. A peak flow meter measures how
hard you can breathe out. Your doctor can

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show you how to monitor your peak flow
at home.

 Identify and treat attacks early. If you

act quickly, you're less likely to have a
severe attack. You also won't need as
much medication to control your
symptoms.

When your peak flow measurements

decrease and alert you to an oncoming Lecture cum LCD
demonstration
attack, take your medication as instructed.
Also, immediately stop any activity that
may have triggered the attack. If your
symptoms don't improve, get medical
help as directed in your action plan.

 Take your medication as

prescribed. Don't change your
medications without first talking to your
doctor, even if your asthma seems to be
improving. It's a good idea to bring your
medications with you to each doctor visit.
Your doctor can make sure you're using
your medications correctly and taking the
 right dose.

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7. To explain the 5 Diagnosis
diagnosis mins
Physical exam

Your doctor will perform a physical exam to

rule out other possible conditions, such as a
respiratory infection or chronic obstructive
pulmonary disease (COPD). Your doctor will
also ask you questions about your signs and
symptoms and about any other health problems. Lecture cum LCD
demonstration
Tests to measure lung function

You may be given lung function tests to

determine how much air moves in and out as
you breathe. These tests may include:

 Spirometry. This test estimates the

narrowing of your bronchial tubes by
checking how much air you can exhale
after a deep breath and how fast you can
breathe out.
  Peak flow. A peak flow meter is a simple
device that measures how hard you can
breathe out. Lower than usual peak flow
readings are a sign that your lungs may
not be working as well and that your
asthma may be getting worse.
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Lung function tests often are done before and
after taking a medication to open your airways
called a bronchodilator (brong-koh-DIE-lay-
tur), such as albuterol. If your lung function
improves with use of a bronchodilator, it's
likely you have asthma.

Additional tests

Other tests to diagnose asthma include: Lecture cum LCD

demonstration
 Methacholine challenge. Methacholine is
a known asthma trigger. When inhaled, it
will cause your airways to narrow
slightly. If you react to the methacholine,
you likely have asthma. This test may be
used even if your initial lung function test
is normal.

 Imaging tests. A chest X-ray can help

identify any structural abnormalities or
diseases (such as infection) that can cause
 or aggravate breathing problems.
Allergy testing. Allergy tests can be performed
by a skin test or blood test. They tell you if
you're allergic to pets, dust, mold or pollen. If
allergy triggers are identified, your doctor may
recommend allergy shots.

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8. To explain the 5 Treatment
treatment mins

Prevention and long-term control are key to

stopping asthma attacks before they start.
Treatment usually involves learning to
recognize your triggers, taking steps to avoid
triggers and tracking your breathing to make
sure your medications are keeping symptoms
under control. In case of an asthma flare-up,
you may need to use a quick-relief inhaler. Lecture cum LCD
demonstration
Medications

The right medications for you depend on a

number of things — your age, symptoms,
asthma triggers and what works best to keep
your asthma under control.

Preventive, long-term control medications

reduce the swelling (inflammation) in your
 airways that leads to symptoms. Quick-relief
inhalers (bronchodilators) quickly open swollen
airways that are limiting breathing. In some
cases, allergy medications are necessary.

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Long-term asthma control
medications, generally taken daily, are the
cornerstone of asthma treatment. These
medications keep asthma under control on a
day-to-day basis and make it less likely you'll
have an asthma attack. Types of long-term
control medications include:

 Inhaled corticosteroids. These
medications include fluticasone Lecture cum LCD
demonstration
propionate (Flovent HFA, Flovent
Diskus, Xhance), budesonide (Pulmicort
Flexhaler, Pulmicort Respules,
Rhinocort), ciclesonide (Alvesco),
beclomethasone (Qvar Redihaler),
mometasone (Asmanex HFA, Asmanex
Twisthaler) and fluticasone furoate
(Arnuity Ellipta).

You may need to use these medications

 for several days to weeks before they
reach their maximum benefit. Unlike oral
corticosteroids, inhaled corticosteroids
have a relatively low risk of serious side
effects.

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 Leukotriene modifiers. These oral
medications — including montelukast
(Singulair), zafirlukast (Accolate) and
zileuton (Zyflo) — help relieve asthma
symptoms.

Montelukast has been linked to

psychological reactions, such as agitation,
aggression, hallucinations, depression and
suicidal thinking. Seek medical advice
Lecture cum LCD
right away if you experience any of these demonstration
reactions.

 Combination inhalers. These medications

— such as fluticasone-salmeterol (Advair
HFA, Airduo Digihaler, others),
budesonide-formoterol (Symbicort),
formoterol-mometasone (Dulera) and
fluticasone furoate-vilanterol (Breo
Ellipta) — contain a long-acting beta
 agonist along with a corticosteroid.

 Theophylline. Theophylline (Theo-24,
Elixophyllin, Theochron) is a daily pill
that helps keep the airways open by
relaxing the muscles around the airways.
It's not used as often as other asthma
medications and requires regular blood
tests.

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Quick-relief (rescue) medications are used as
needed for rapid, short-term symptom relief
during an asthma attack. They may also be used
before exercise if your doctor recommends it.
Types of quick-relief medications include:

 Short-acting beta agonists. These

inhaled, quick-relief bronchodilators act
within minutes to rapidly ease symptoms
during an asthma attack. They include Lecture cum LCD
demonstration
albuterol (ProAir HFA, Ventolin HFA,
others) and levalbuterol (Xopenex,
Xopenex HFA).

Short-acting beta agonists can be taken

using a portable, hand-held inhaler or a
nebulizer, a machine that converts asthma
medications to a fine mist. They're
 inhaled through a face mask or
mouthpiece.
Anticholinergic agents. Like other
bronchodilators, ipratropium (Atrovent HFA)
and tiotropium (Spiriva, Spiriva Respimat) act
quickly to immediately relax your airways,
making it easier to breathe. They're mostly used
for emphysema and chronic bronchitis, but can
be used to treat asthma.

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Bronchial thermoplasty

This treatment is used for severe asthma that

doesn't improve with inhaled corticosteroids or
other long-term asthma medications. It isn't
widely available nor right for everyone.

During bronchial thermoplasty, your doctor

heats the insides of the airways in the lungs
with an electrode. The heat reduces the smooth
muscle inside the airways. This limits the
ability of the airways to tighten, making Lecture cum LCD
breathing easier and possibly reducing asthma demonstration
attacks. The therapy is generally done over
three outpatient visits.

Treat by severity for better control: A

stepwise approach

Your treatment should be flexible and based on

changes in your symptoms. Your doctor should
 ask about your symptoms at each visit. Based
on your signs and symptoms, your doctor can
adjust your treatment accordingly.

For example, if your asthma is well controlled,

your doctor may prescribe less medication. If
your asthma isn't well controlled or is getting
worse, your doctor may increase your
medication and recommend more-frequent
visits.

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BIBLIOGRAPHY

1. Weinberger SE, et al. Asthma. In:

Principles of Pulmonary Medicine. 7th
ed. Elsevier; 2019.
https://www.clinicalkey.com. Accessed
March 30, 2020.
2. Asthma. National Heart, Lung, and
Blood Institute.
https://www.nhlbi.nih.gov/health-
topics/asthma. Accessed March 25,
2020.
3. AskMayoExpert. Asthma (adult). Mayo
Clinic; 2020.
4. Global strategy for asthma management
and prevention (2019 update). Global
Initiative for Asthma.
 https://ginasthma.org/gina-reports/.
Accessed March 27, 2020.
5. Khurana S, et al. Systematic approach to
asthma of varying severity. Clinics in
Chest Medicine. 2019;
doi:10.1016/j.ccm.2018.10.004.
 CLASS TEACHING: BRONCHIAL ASTHMA
SUBMITTED TO SUBMITTED BY
Dimpal Sahu
M.Sc (n) 2nd year