By

Group II
History of Asthma

 Asthma is not a recent condition, in fact there

is written evidence for asthma from ancient
Egyptian times.
 During 1870s, in Egypt the Papyrus has been
found which contains the prescriptions for
asthma remedy.
 Term asthma is a Greek word that is derived
from the verb aazein, meaning to exhale with
open mouth,to pant.
What Is Asthma?

 Asthma is a chronic lung disease occur due to

inflammation in the airways and makes it
narrower which obstructs the flow of air into
and out of the lungs.
 It also makes the airways more sensitive to
certain substances that might be inhaled
called allergens.
 Asthma affects the airways of our lungs.
Classifications

 Asthma is clinically classified according to the

frequency of symptoms, forced expiratory
volume in 1 second (FEV1), and peak
expiratory flow rate. 
 Asthma may also be classified as atopic
(extrinsic) or non-atopic (intrinsic), based on
whether symptoms are precipitated by
allergens (atopic) or not (non-atopic).[9]
Types of Asthma

 Intermittent
 Mild persistent
 Moderate persistent
 Severe persistent
The episode of asthma:
 The lining of the airways becomes swollen
(inflamed).
 The airways produce a thick mucus.
 The muscles around the airways tighten and
make the airways narrower.
 These changes in the airways block the flow of
air, making it hard to breathe.
Physiopathology of Asthma
Immunohistopathologic
features of asthma:
 Neutrophils
 Eosinophils
 Mast cell Activation
 Epithelial cell injury
 Genetic Factors
PATHOPHYSIOLOGY AND
PATHOGENESIS OF ASTHMA
 Bronchoconstrction
 Airway oedema
 Airway hyper responsiveness
 Airway remodelling
1.Bronchoconstriction

 Major Mediators
 Histamine
 Tryptase
 Leukotrienes
 Prostaglandins
 Other Mediators
 Exercise
 Cold air
 Irritant
2.Airway oedema

 Oedema
 Inflammation
 Mucus hypersecretion
 Mucus plugs
 Hypertrophy
 Hyperplasia
3.Airway
Hyperresponsiveness
 Inflammation : It is the major factor in
determining the degree of airway
hyperresponsiveness

 Dysfunctional neuro regulation

 Structural changes
4.Airway remodelling

 Permanent structural changes of airway : It

will lead to progressive lose of function of
lungs.

 Loss of lung function : Once it happen it

cannot prevented by or fully reversible by
current therapy .
Causes And Symptoms
The main symptoms of asthma are:
· coughing
· shortness of breath
· wheezing
· tightness of the chest
· unable to sleep through the night
without symptoms
· unable to exercise without
symptoms
· prolonged coughing or wheezing
after viral infection
Early warning signs
of an asthma episode
Asthma episodes rarely come on suddenly.
Often there are clues or early warning signs
that an episode may occur. Some early
warning signs may be:
· runny nose
· coughing
· shortness of breath
· not sleeping well at night
Factors Responsible for Asthma

 Non-specific factors:
All asthma patients are affected by a number of
things that are referred to as irritants. They include
exertion, cold, smoke, scents and pollution.
 Specific factors:
These are irritants or allergens in the form of
pollen, dust, animal fur, mould and some kinds of
food. A virus or bacteria, chemical fumes or other
substances at the workplace and certain medicines,
eg aspirin and other non-steroidal anti-
inflammatory drugs (NSAIDs), may also cause
asthma.
 Asthma is a chronic disease that is not
curable. The most effective asthma treatment
plan includes a multifaceted approach this
includes preventive care, which is vital in
minimizing asthma attacks.
There are two major groups of medication used
in controlling asthma:
 Anti inflammatories(corticosteroids)
 Bronchodilators.
 Anti inflammatories reduce the no of
inflammatory cells in the air ways and prevent
blood vessels from leaking fluid in to the air
way tissues. By reducing inflammation, it
reduces the spontaneous spasm of the airway
muscle.
 Anti inflammatories are used as a preventive

measure to lesser the risk of accute asthma

attacks. Eg: flunisolide, triamcinolone.
 Bronchodilators are dilators work by
increasing the diameter of air passages and
easing the flow of gases to and from the
lungs.
eg:Metaproterenol, ephedrin.
 Long term asthma control medication
 Quick relief medication (rescue medication)
 Allergy induced medication
 Medication include long term agents that
control and prevent symptoms. Long term
medication must taken daily in a consistent
manner to effectively control and prevent
symptoms. They generally work by reducing
airway inflammation and include inhaled
corticosteroids.
 Short-acting bronchodilators are considered
"quick-relief" or rescue medications used to
treat coughing wheezing or chest tightness
associated with acute asthma flare-ups.
Commonly used bronchodilators include the
short-acting beta-2 agonists albuterol,
pirbuterol, levalbuterol and bitolterol, the
anticholinergic drug atrovent, and the oral
steroids prednisone or prednisolone.
 Treatment of allergy-induced asthma involves
decreasing the body's sensitivity and immune
response to particular allergens. According to
the Mayo Clinic, omalizumab, an anti-IgE
monoclonal antibody, is a medication
delivered by injection every 2 to 4 weeks to
reduce immune hypersensitivity responses.
Another treatment alternative is
immunotherapy.
 Mainly 2 Types
 Peak Expiratory Flow (PEF) Test
 Spirometry Test
. A peak flow meter is a portable device that can be
carried by the patient
It consists of a small tube with a gauge that
measures the maximum force with which one can
blow air through the tube
The patient performs the peak flow meter test twice
a day for about 2 weeks and records the results for
review
. The first test should be performed in the morning
before taking bronchodilator medications
The second test should be done in the afternoon
after taking a bronchodilator
. Peak flows vary during the early morning and
evening.
Morning peak is lower than the evening peak.
A variability greater than 20% indicates a airway
obstruction
Peak flow chart
• Spirometry uses a measuring device called
a spirometer 
• Can be used to airway obstruction due
to triggers.
• The patient exhales and inhales deeply,
then seals his or her lips around the
mouthpaiece and blows as forcefully
and for as long as possible until all the
air is exhaled from the lungs.
 The spirometer measures the amount of air
exhaled and the length of time it took to
exhale it.
 The amount of air exhaled in the first second
(FEV1), is measured and compared to the
total amount exhaled.
 If the amount exhaled in 1 second is
disproportionately low to the total exhaled,
the patient has an obstruction
 Avoidance of triggers is a key component of
preventing attacks
 Reducing Exposure to
Environmental Tobacco Smoke
 Keep the house clean to reduce allergens like
dust mites, pollen.
 Reduce humidity level
 Reducing Exposure to Pets
 Reducing Exposure to Mold
 Schedule an asthma check up every 6
months to get prescriptions renewed
 Minimize exposure to combustion particles
and gases that can cause breathing
difficulties for people with asthma.
 Share the asthma action plan with
school/daycare
New therapies
BRONCHIAL THERMOPLASTY

 Dr. Mario Castro, a pulmonologist at Washington University School of Medicine in

St. Louis, Missouri, Castro led a clinical trial testing the first ever non-drug
treatment for severe asthma. 

 The FDA based its approval on data from a clinical trial of 297 patients with
severe and persistent asthma.

Alair system

 The trial showed a reduction of severe asthma attacks.

 The device is composed of a catheter with an electrode tip that delivers a form of
electromagnetic energy, called radiofrequency energy, directly to the airways.

 A controller unit generates and controls the energy.

 The Alair system treats asthma symptoms by using radiofrequency
energy to heat the lung tissue in a controlled manner, reducing the
thickness of smooth muscle in the airways and improving a patient's
ability to breathe.

 To benefit, patients will require multiple sessions targeting different

areas in the lung.

 The Alair system is not for use in asthma patients with a pacemaker, or
other implantable electronic device.
NONSTEROIDAL TREATMENT OF ASTHMA
ScienceDaily (July 6, 2010) 
 A new nonsteroidal, anti-inflammatory therapy made from a human
protein significantly decreases disease signs of asthma in mice, opening
the possibility of a new asthma therapy for patients who do not respond
to current steroid treatments.

 Results of this therapy in an animal model were presented at The

Endocrine Society's 92nd Annual Meeting in San Diego.

 The protein, insulin-like growth factor binding protein-3 (IGFBP-3),

uniquely inhibits specific physiological consequences of asthma
examined in asthmatic mice.

 IGFBP-3 reportedly targets a key cellular pathway called nuclear factor

kappa B, or NF-κB that plays a role in inflammation. The IGFBP-3 protein
interferes with its cellular signaling and suppresses NF-κB activity.
 "Anti-inflammatory corticosteroid medicines are an important part of
asthma management for many people, but an estimated 20 percent of
patients with asthma are resistant to existing steroid medications and
there is a critical need for alternate therapies," Oh said.

 The researchers administered IGFBP-3 to the mice by spraying a

synthetic form of the protein into their opened trachea.

 The treatment "reduced all physiological manifestations of asthma,"

including airway inflammation and hyperreactivity,

 This novel mechanism claimed to have implications not only for asthma
but also other inflammatory diseases that
NF-κB plays a role in, such as atherosclerosis and rheumatoid arthritis,"
Asthma Facts and Figures

 More people than ever say they are suffering from asthma. It is
this country's most common and costly illness.
 The prevalence of asthma has been increasing since the early
1980’s across all age, sex and racial groups. Asthma is more
prevalent among children than adults, and among blacks than
whites.
 An estimated 26 million Americans suffer from asthma, nearly 8
million are under age 18. It is the most common chronic
childhood disease.
 Each day 14 Americans die from asthma.
 Between 1979 and 1992, asthma related death rates increased 58
percent overall. The death rate for children less than 19 years old
increased by 78 percent.
 More females die of asthma than males and more blacks die of
asthma than whites.
References:
 Von Mutius E, Martinez FD, Fritzsch C, et al.: "Skin test reactivity and
number of siblings." BMJ 1994; 308:692-695.
 ^ Jarvis D, Chinn S, Luczynska C, Burney P: "The association of family size
with atopy and atopic disease." Clin Exp Allergy1997; 27:240-245.
 ^ Ball TM, Castro-Rodriguez JA, Griffith KA, et al.: "Siblings, day-care
attendance, and the risk of asthma and wheezing during childhood. N Engl J
Med 2000; 343:538-543. etc)
 ^ Pattemore PK, Johnston SL, Bardin PG: "Viruses as precipitants of asthma
symptoms. I Epidemiology." Clin Exp Allergy 1992; 22:325-336.
 ^ Nicholson KG, Kent J,chloes loves kurt Ireland DC: "Respiratory viruses and
exacerbations of asthma in adults."BMJ 1993; 307:982-996.
 www.medicine net.com
 www.nih.gov.in