ASTHMA

By Mawaddah I. Nazer
21120413
CONTENTS OF THIS TEMPLATE
1-Definition of Asthma

2-Risk Factor

3-Causes

4-Pathophysiology of Asthma

5-Classification of Asthma Severity

6-Diagnosis of Asthma

7-Treatment of Asthma
Definition of Asthma
Asthma is a chronic heterogeneous inflammatory
disease characterized by the history of respiratory
symptoms such as wheeze, shortness of breath, chest
tightness and cough that vary over time and in
intensity, together with variable expiratory airflow
limitation

Inflammation of the airways causes symptoms like

wheezing, breathlessness (dyspnea), chest
tightness, and coughing. The severity and frequency
of these symptoms can vary and may become worse
at night or in the early morning
 Risk Factors
Patient-Related Factors Medication & Treatment-Related
• Genetic predisposition (Family history of Factors
asthma or atopy)
• High usage of relievers (Over-reliance on short-
• History of severe asthma attacks (Past 12
acting beta-agonists)
months, prior ICU admissions)
• Frequent use of oral corticosteroids (OCS
• Low lung function (Low FEV1)
overuse leading to poor asthma control)
• Major psychological disorders (Anxiety,
• Inadequate use of inhaled corticosteroids (ICS)
depression, stress)
(Poor adherence, improper inhaler technique)

Environmental-Lifestyle Factors Physiological & Health Status

• Smoking and vaping (Tobacco smoke exposure, e-
cigarettes)
Factors
• Exposure to allergens (Dust mites, pollen, mold, pet • Pregnancy (Hormonal changes affecting
dander) airway reactivity)
• Occupational exposure (Chemical irritants, industrial • Obesity (Increased inflammation and airway
dust) resistance)
• Air pollution (Indoor and outdoor pollutants) • Reduced socioeconomic status (Limited
access to healthcare, increased exposure to risk
factors)
 Causes
Asthma is influenced by a variety of triggers rather than a single cause, These factors can
provoke or worsen asthma symptoms, especially in susceptible individuals:

01 Allergens
Pollen, especially during seasonal changes.
Dust mites, often found in bedding and upholstered furniture. 04 Environmental irritants
Pet dander from cats, dogs, and other furry animals. Tobacco smoke (active or second-hand).
Mold spores, especially in damp indoor environments. Air pollution, including car exhaust and industrial
fumes.
02 Respiratory infections Strong odors from perfumes, cleaning agents, and
incense (like Bukhoor).
Viral infections such as rhinovirus, influenza, and respiratory
Occupational exposures to chemicals, dust, or fumes
syncytial virus (RSV) are major causes of exacerbations.
(e.g., in factories or hair salons).
Particularly impactful in children and during flu seasons.
Emotional and psychological triggers:
Strong emotions, such as intense laughter, crying, or
03 Physical activity stress.
Exercise-induced asthma, particularly triggered by strenuous Anxiety or panic attacks can lead to hyperventilation
exertion, cold air, or dry climates. and symptom flare-up.
 Causes

05 Hormonal influences 06 Weather changes

Menstruation, pregnancy, and menopause can Sudden exposure to cold air, low humidity, or
affect asthma control in some women. extreme heat.
Sandstorms (especially common in Middle Eastern
regions) may worsen symptoms.

07 Medications
Aspirin and other NSAIDs (like ibuprofen), especially in individuals
with AERD (aspirin-exacerbated respiratory disease).
Beta-blockers, even when used in eye drops, can provoke
bronchospasm in sensitive patients.
Pathophysiology of Asthma
1-Chronic inflammation of the airways, leading to:

Bronchospasm (smooth muscle constriction)

Mucosal edema (swelling of airway lining)
Mucus hypersecretion

2-Airway remodeling occurs with persistent inflammation,

resulting in:
Subepithelial fibrosis (scarring beneath the airway lining)
Smooth muscle hypertrophy (thickening of airway muscles)
Thickened airway walls, leading to partially irreversible
airflow limitation

3-Immune cells involved:

Th2 cells, eosinophils, mast cells, dendritic cells
Also involves IL-4, IL-5, IL-13 in type 2 inflammation
Pathophysiology of Asthma
4-Types of airway inflammation:
A)Type 2-high (Th2) inflammation:
Includes allergic asthma, eosinophilic asthma, and aspirin-
exacerbated respiratory disease (AERD)
Usually responsive to corticosteroids and biologic therapies
B)Type 2-low (non-Th2) inflammation:
Includes neutrophilic asthma and pauci-granulocytic asthma
Typically seen in adults
Often less responsive to corticosteroids

5-Airway hyperresponsiveness (AHR):

A defining feature of asthma
Airway muscles are overly sensitive to various stimuli
More pronounced during and after exacerbations

6-Exacerbations:
Frequently triggered by viral infections (e.g., rhinovirus)
Can lead to sudden worsening of symptoms and progressive
lung function decline
 Classification of Asthma Severity
Asthma severity is assessed retrospectively based on the minimum level of treatment
required to achieve sustained control over a period of at least 3 months.
It is classified into:

Mild Asthma
Symptoms are controlled using Step 1 or Step 2 treatment.
Typically managed with as-needed ICS-formoterol or low-dose ICS.

01
Severe Asthma Moderate Asthma
Requires Step 4 or 5 treatment to maintain Requires Step 3 treatment for adequate
control. 02 03 control.
May include high-dose ICS/LABA, with or Managed with low to medium-dose
without biologics. ICS/LABA combinations.
May remain uncontrolled despite maximal
standard therapy.

Note: This classification is dynamic, not fixed. A patient’s severity level can change over
time, and assessment should be ongoing to guide treatment intensity and monitoring.
 Diagnosis of Asthma
1-Clinical History:
-Look for key symptoms: wheezing, chronic cough, chest tightness, and breathlessness.
-Assess variability of symptoms over time and response to triggers.
-Symptoms that worsen at night or during exercise are particularly suggestive.

2-Physical Examination:
-May show expiratory wheeze, especially during exacerbations.
-Physical findings can be normal between episodes.

3-Spirometry:
-Confirms reversible airflow obstruction.
-Diagnostic if FEV1 improves ≥12% and ≥200 mL after a bronchodilator.

4-Peak Flow Monitoring:

-Shows variability >10% when measured twice daily over 2 weeks.

5-FeNO Testing:
-Indicates airway eosinophilic inflammation (elevated in Type 2 asthma).
 Diagnosis of Asthma

6-Bronchoprovocation Testing:
-Used if spirometry is normal but asthma is still suspected.
-Measures airway hyperresponsiveness (e.g., methacholine challenge).

7-Allergy Testing:
-Skin prick tests or RAST can help identify allergen sensitization.

8-Chest X-ray:
-Not routinely needed unless there are atypical symptoms or suspicion of alternative
diagnoses

9-Therapeutic Trial:
-A trial of inhaled corticosteroids (ICS) may help confirm diagnosis if tests are
inconclusive but symptoms suggest asthma.
 Treatmant of Asthma
General Principles of Treatment:
• Use a stepwise approach to adjust therapy based on
control level.
• Target “Goal of treatment” : Achieve and maintain asthma
control with the minimum effective dose.
• Base treatment decisions on clinical assessment,
spirometry, ACT score, and exacerbation risk .
 1-Non-Pharmacological

A)Environmental and Allergen Control B)Lifestyle Modifications

• Avoid exposure to triggers such as: Weight:
1. Tobacco smoke (active and passive). 1. Obesity is linked to poor asthma
2. Incense smoke, air pollution, strong control and increased exacerbations.
odors (e.g., perfumes, cleaning 2. Encourage healthy diet and regular
chemicals). exercise (with pre-exercise
3. Dust mites (use allergen-proof bronchodilation if needed).
bedding, wash sheets in hot water).
4. Mold, cockroaches, and pet dander. Smoking cessation:
1. Strongly encouraged in all patients.
Outdoor exposure management: 2. Smoking reduces response to ICS and
1. Limit outdoor activity during high- increases exacerbation risk.
pollen seasons or sandstorms.
2. Use air purifiers and air-conditioning Physical activity:
filters. 1. Promote controlled exercise.
3. Close windows during dust storms or 2. Use a reliever before exercise if
heavy pollution. exercise-induced symptoms are
present.
Occupational exposure:
1. Identify and avoid sensitizing agents Stress:
in workplaces (e.g., chemicals, flour, 1. Address anxiety and depression which
latex). can worsen symptoms.
2. Early withdrawal from exposure 2. Consider cognitive behavioral therapy
improves prognosis. or support groups if needed.
 Treatmant of Asthma
2-Pharmacological Treatment

A)Short acting beta 2 agonist( Salmeterol):

provide quick relief from acute asthma symptoms by
relaxing bronchial muscles. rapid onset of action (5 to 30
minutes) and duration for4 to 6 hours.

B)Long-Acting Beta-2 Agonists LABAs(Formoterol):

Used for long-term asthma control and typically paired
with inhaled corticosteroids. They maintain
bronchodilation for at least 12 hours and are not
recommended as monotherapy due to safety concerns.

C)Corticosteroids
Potent anti-inflammatory agents that:
• Inhibit phospholipase A2
• Reduce prostaglandin and leukotriene production
• Decrease airway inflammatory cells
• Stabilize mast cells, thus minimizing histamine release
 Treatmant of Asthma
3-Other Medication Classes

A)Leukotriene Receptor Antagonists

These drugs block or inhibit the synthesis of leukotrienes
to manage:
• Allergic rhinitis
• Allergic asthma
• Exercise-induced bronchospasm

B)Muscarinic Antagonists
Used as adjunct bronchodilators, particularly in cases
unresponsive to beta-agonists.

C)Biologic Therapies
Targeted treatments for moderate-to-severe asthma:
• Anti-IgE: Omalizumab
• Anti-IL-5: Mepolizumab
• Anti-IL-5 Receptor: Benralizumab
• Anti-IL-4Rα: Dupilumab
• Anti-TSLP: Tezepelumab
 Common Adverse Drug Reactions

01 SABAs 02 LABAs
Tremors, tachycardia, Similar to SABAs;
palpitations, anxiety monotherapy increases risk
of asthma-related death

03 Corticosteroids 04 Leukotriene Antagonists

Oral thrush, systemic effects Headaches, GI upset, rare
(e.g., weight gain, osteoporosis), liver issues
skin fragility

05 Muscarinic Antagonists 06 Biologics

Injection site reactions, rare
Dry mouth, constipation, urinary
anaphylaxis (especially with
retention
Omalizumab)
Stepwise Asthma Management
Step 1 – Mild Intermittent Asthma Criteria:
• Daytime symptoms ≤2 days/week
• ≤2 nocturnal awakenings/month
• Normal FEV1
• ≤1 exacerbation/year

Preferred Option:
Low-dose ICS-formoterol as needed
Alternatives: ICS + SABA as needed or SABA alone

Step 2 – Mild Persistent Asthma Criteria:

• Symptoms 3–6 days/week
• 2–4 nocturnal awakenings/month
• Minor activity limitation
• ≥2 exacerbations/year requiring oral steroids

Preferred Option: Low-dose ICS-formoterol as needed

Alternatives:
Daily low-dose ICS or anti-inflammatory reliever therapy
Stepwise Asthma Management
Step 3 – Moderate Asthma Criteria:
• Daily symptoms
• Nocturnal symptoms >1/week
• Some activity limitations
• FEV1 60–80% predicted

Preferred Option:
Low-dose ICS-formoterol as both maintenance and reliever
Alternatives:Low-dose ICS-LABA, ICS + LAMA, or LTRA

Step 4 – Severe Persistent Asthma Criteria:

• Frequent activity limitation
• Nightly symptoms
• FEV1 <60% predicted

Preferred Option:
Medium-dose ICS-formoterol as maintenance and reliever
Alternatives: Medium-dose ICS-LABA, ICS + LAMA or LTRA
 Patient Education & Monitoring

01 02 03 04 05

Inhaler Technique: Adherence: Trigger Monitoring: Counseling:

Correct usage Non-compliance Avoidance: Regular ACT Empowering
ensures drug is a major cause Identifying and scores, spirometry, patients through
delivery of treatment avoiding allergens and follow-ups education enhances
failure or irritants outcomes
THANK
you