นส.นุชนาถ ตั้งเวนิชเจริญสุข รหัส 490940-660
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•A chronic inflammatory disorder of the airway
•Airway hyperresponsiveness
•Recurrent episodes of wheezing, coughingand shortness of breath
•Widespread, variable and often reversibleairflow limitation
Definition
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INFLAMMATIONINFLAMMATION
Risk Factors (for development of asthma)
AirwayHyperresponsiveness
Airflow Limitation
Symptoms-(shortness of breath,cough, wheeze)
Mechanism
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Risk factor
Allergens
Occupational
Genetics
Respiratory infections
Environmental exposures
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Diagnosis
History and patterns of symptoms
•attack or recurrent episodes of wheezing?
•troublesome cough, worse particularly at nightor on awakening?
•cough after physical activity (e.g. playing)?
•breathing problems during a particular season(or change of season)?
•use any medication (e.g. bronchodilator)when symptoms occur? Is there a response?
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Diagnosis
Measurements of lung function
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Classification of Asthma Severity
STEP 4
SeverePersistent
STEP 3
ModeratePersistent
STEP 2
MildPersistent
STEP 1
Intermittent
Symptoms
NighttimeSymptoms
PEF
CLASSIFY SEVERITYClinical Features Before Treatment
Continuous
Limited physicalactivity
Daily
Use 2-agonist dailyAttacks affect activity
>1 time a weekbut <1 time a day
< 1 time a week
Asymptomaticand normal PEFbetween attacks
Frequent
>1 time week
>2 times a month
<2 times a month
<60% predicted
Variability >30%
>60%-<80%predicted
Variability >30%
>80% predicted
Variability 20-30%
>80% predicted
Variability <20%
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Therapy at each stage of Asthma
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Patients are not detected
Do not seek medical attention
No access to health service
Missed diagnosis (bronchitis, LRTI)
The treatment Gap in Asthma