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YOUSEF ABDULLAH AL TURKI MBBS,DPHC,ABFM Associate Professor Consultant Family Medicine King Khalid University Hospital College of Medicine King Saud University
CASE SCENARIO
Khalid 14 years old come to the clinic c/o shortness of breath for one day duration. He is a known asthmatic patient for more than 8 years, he visited A/E frequently. His school performance is below average, with frequent absence from school due to his illness.
Prevent troublesome symptoms night and day Prevent serious attacks Require little or no reliever medication Have productive, physical, psychological, and social active lives
Range
Pathophysiology (Cont.)
Airway wall swelling (mucosal edema) Airway hyper responsiveness Chronic changes Hypertrophy of the smooth muscles, thickening of the basement membrane Airway remodeling There is good evidence that asthma occurs in families.
CASE SCENARIO
Ahmed 6 years old come to primary care clinic with his father c/o chronic cough for the last 3 months, mainly at night .
skill Relevant History -Symptom -history of allergic disease -Family history -Environmental history -Exclusion of other medical condition
physical examination Investigation Do you need to do investigation? Why ? Follow up Medical record Role of Peak Flow Meter
intermittent Asthma (step1) Mild persistent Asthma (step2) Moderate persistent Asthma (step3) Severe persistent Asthma (step4)
patients to develop a partnership in asthma care Assess and monitor asthma severity Avoid exposure to trigger factors Establish individual medication plans for long term management in children and adults
mild Intermitte nt
< 1/week
Mild persistent
1-3 /week
Moderate persistent
4-5/week
Severe persistent
Continuou s
>80%
>80%
Step 1
Step 2
Step 3
Step 4
mild Intermitte nt
< 2 /week <2 /month >80%
Mild persistent
2-3 /week 2-3 /month >80%
Moderate persistent
4-5 /week 4-5 /month 60-80%
Severe persistent
Continuou s >5 /month < 60%
Step 1
Step 2
Step 3
Step 4
INTERNET SITE
Guidelines
NHLBI/ WHO report http://www.ginasthma.com Cochrane Site: http://www.cochrane.org/ Clinical Evidence: http://www.clinicalevidence.org
QUESTIONS ????
THANK YOU
WITH MY BEST REGARDS
PRACTICAL
GROUP (A) - Simple clinical algorithm for management of bronchial asthma among ADULT in PHC clinic GROUP (B) - Simple clinical algorithm for management of bronchial asthma among CHILDREN in PHC clinic Group (c) - Simple clinical algorithm for management of bronchial asthma in EMERGENCY