Management of Bronchial Asthma

import matplotlib
matplotlib.use("Agg")
import matplotlib.pyplot as plt
import matplotlib.patches as mpatches
from matplotlib.patches import FancyBboxPatch, FancyArrowPatch

# ── Canvas ────────────────────────────────────────────────────────
fig = plt.figure(figsize=(22, 30), facecolor="#F8FAFC")
ax  = fig.add_axes([0, 0, 1, 1])
ax.set_xlim(0, 22)
ax.set_ylim(0, 30)
ax.axis("off")

# ── Palette ───────────────────────────────────────────────────────
NAVY    = "#1A355E"
TEAL    = "#007A87"
GREEN   = "#1E7A45"
AMBER   = "#E67E22"
RED     = "#C0392B"
PURPLE  = "#6C3483"
LGREY   = "#EAF0F6"
MGREY   = "#D5E8F0"
LYELLOW = "#FEF9E7"
LGREEN  = "#E9F7EF"
LORANGE = "#FDF2E9"
LRED    = "#FDEDEC"
LPURPLE = "#F4ECF7"
WHITE   = "#FFFFFF"
DARK    = "#1C1C1C"

# ── Helper functions ──────────────────────────────────────────────
def box(ax, x, y, w, h, text, bg=LGREY, border=NAVY, fontsize=8.5,
        bold=False, text_color=DARK, radius=0.25, alpha=1.0, linew=1.5,
        va="center", ha="center", wrap=False):
    rect = FancyBboxPatch((x - w/2, y - h/2), w, h,
                          boxstyle=f"round,pad=0.05,rounding_size={radius}",
                          facecolor=bg, edgecolor=border,
                          linewidth=linew, zorder=3, alpha=alpha)
    ax.add_patch(rect)
    weight = "bold" if bold else "normal"
    ax.text(x, y, text, ha=ha, va=va, fontsize=fontsize,
            color=text_color, fontweight=weight, zorder=4,
            wrap=wrap, multialignment="center",
            linespacing=1.35)

def header_box(ax, x, y, w, h, text, bg=NAVY, fontsize=10, text_color=WHITE):
    rect = FancyBboxPatch((x - w/2, y - h/2), w, h,
                          boxstyle="round,pad=0.05,rounding_size=0.3",
                          facecolor=bg, edgecolor=bg,
                          linewidth=2, zorder=3)
    ax.add_patch(rect)
    ax.text(x, y, text, ha="center", va="center", fontsize=fontsize,
            color=text_color, fontweight="bold", zorder=4,
            multialignment="center", linespacing=1.3)

def arrow(ax, x1, y1, x2, y2, color=NAVY, lw=1.8, style="->"):
    ax.annotate("", xy=(x2, y2), xytext=(x1, y1),
                arrowprops=dict(arrowstyle=style, color=color,
                                lw=lw, connectionstyle="arc3,rad=0.0"),
                zorder=2)

def label_arrow(ax, x1, y1, x2, y2, label, color=AMBER, fontsize=7.5, lw=1.8):
    ax.annotate("", xy=(x2, y2), xytext=(x1, y1),
                arrowprops=dict(arrowstyle="->", color=color, lw=lw),
                zorder=2)
    mx, my = (x1+x2)/2, (y1+y2)/2
    ax.text(mx+0.08, my, label, fontsize=fontsize, color=color,
            fontweight="bold", zorder=5)

def diamond(ax, x, y, w, h, text, bg=LYELLOW, border=AMBER, fontsize=8):
    dx, dy = w/2, h/2
    pts = [(x, y+dy), (x+dx, y), (x, y-dy), (x-dx, y)]
    from matplotlib.patches import Polygon
    poly = Polygon(pts, closed=True, facecolor=bg, edgecolor=border,
                   linewidth=2, zorder=3)
    ax.add_patch(poly)
    ax.text(x, y, text, ha="center", va="center", fontsize=fontsize,
            fontweight="bold", color=DARK, zorder=4, multialignment="center",
            linespacing=1.3)

def divider(ax, y, color="#CCCCCC"):
    ax.plot([0.3, 21.7], [y, y], color=color, lw=0.8, ls="--", zorder=1)

# ══════════════════════════════════════════════════════════════════
#   TITLE
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 29.3, 21.4, 0.9,
           "BRONCHIAL ASTHMA — Clinical Management Flowchart\n"
           "Harrison's 22E (2025)  ·  GINA 2026  ·  Murray & Nadel's",
           bg=NAVY, fontsize=10.5)

# ══════════════════════════════════════════════════════════════════
#   SECTION A  —  DIAGNOSIS & CONTROL ASSESSMENT
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 28.5, 21.4, 0.5,
           "STEP 1 — DIAGNOSIS  &  CONTROL ASSESSMENT", bg=TEAL, fontsize=9.5)

# --- GINA 4-question tool
box(ax, 5.5, 27.3, 10.0, 1.4,
    "GINA SYMPTOM CONTROL  (past 4 weeks)\n"
    "①  Daytime symptoms >2×/week?\n"
    "②  Any night waking due to asthma?\n"
    "③  Reliever needed >2×/week?\n"
    "④  Any activity limitation?",
    bg=LGREY, border=TEAL, fontsize=8, bold=False)

# --- Scoring
box(ax, 5.5, 25.85, 9.8, 0.9,
    "0 Yes = Well controlled    |    1–2 Yes = Partly controlled    |    3–4 Yes = Uncontrolled",
    bg=MGREY, border=TEAL, fontsize=8.5, bold=True)

arrow(ax, 5.5, 26.6, 5.5, 26.3)

# --- Severity classification (right column)
box(ax, 16.8, 27.0, 8.2, 1.8,
    "SEVERITY  (GINA)\n\n"
    " Mild  →  Controlled at Step 1–2\n"
    " Moderate  →  Controlled at Step 3\n"
    " Severe  →  Requires Step 4–5",
    bg=LGREEN, border=GREEN, fontsize=8.5, bold=False)

# connector between two panels
ax.plot([10.5, 12.5], [27.3, 27.3], color=TEAL, lw=1.2, ls="--", zorder=2)
ax.plot([12.5, 12.5], [27.3, 27.05], color=TEAL, lw=1.2, ls="--", zorder=2)
arrow(ax, 12.5, 27.05, 12.7, 27.05)

divider(ax, 25.35)

# ══════════════════════════════════════════════════════════════════
#   SECTION B  —  NON-PHARMACOLOGIC  +  CHECK BEFORE STEPPING UP
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 25.1, 21.4, 0.45,
           "STEP 2 — NON-PHARMACOLOGIC MEASURES  (ALL PATIENTS)", bg=GREEN, fontsize=9)

box(ax, 7.0, 24.15, 13.0, 1.3,
    "• Remove triggers: allergens, smoke, occupational antigens, pets\n"
    "• Vaccinate: annual influenza · pneumococcal · COVID-19 · RSV\n"
    "• Allergen immunotherapy (mild–moderate allergic asthma, controlled)\n"
    "• Treat comorbidities: rhinosinusitis · GERD · obesity · OSA · anxiety",
    bg=LGREEN, border=GREEN, fontsize=8.2)

box(ax, 18.5, 24.15, 7.0, 1.3,
    "CHECK FIRST before stepping up:\n"
    "✓  Inhaler technique correct?\n"
    "✓  Adherence adequate?\n"
    "✓  Comorbidities treated?",
    bg=LYELLOW, border=AMBER, fontsize=8.2)

arrow(ax, 11, 25.1, 11, 24.8)

divider(ax, 23.5)

# ══════════════════════════════════════════════════════════════════
#   SECTION C  —  STEPWISE PHARMACOTHERAPY
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 23.25, 21.4, 0.45,
           "STEP 3 — STEPWISE PHARMACOTHERAPY  (Adults & Adolescents ≥12 yrs)", bg=NAVY, fontsize=9.5)

arrow(ax, 11, 23.5, 11, 23.25)

# GINA 2026 alert banner
box(ax, 11, 22.85, 21.0, 0.6,
    "⚑  GINA 2026 SHIFT:  SABA alone NO LONGER preferred at any step."
    "  All patients need ICS-containing therapy."
    "  ICS-formoterol = preferred reliever at ALL steps.",
    bg="#FDEDEC", border=RED, fontsize=8.5, bold=True, text_color=RED)

# --- Step labels (vertical cascade, left column)
step_data = [
    # (y_center, step_label, bg, border, controller, reliever, note_color, note)
    (21.85, "STEP 1\nIntermittent",  "#E8F8F5", TEAL,
     "No daily controller\n(AIR track)\nOR  Low-dose ICS daily",
     "★ As-needed ICS-formoterol\n   (preferred)\nOR  ICS-SABA combo (new 2026)\n   [not SABA alone]",
     TEAL, ""),
    (20.35, "STEP 2\nMild\nPersistent", "#EAF4FB", "#2980B9",
     "Low-dose ICS daily\n(Alt: LTRA if ICS intolerable)",
     "★ As-needed ICS-formoterol\nOR  SABA + concurrent ICS\n⚠  Montelukast: FDA black-box\n    (suicidal ideation)",
     "#2980B9", ""),
    (18.70, "STEP 3\nModerate\nPersistent", "#FEF9E7", AMBER,
     "Low-dose ICS-LABA\n(preferred)\nAlt: Medium ICS  or  ICS+LTRA",
     "★★ MART strategy\n    (ICS-formoterol for\n     maintenance + relief)",
     AMBER, ""),
    (17.10, "STEP 4\nSevere", "#FDF2E9", "#E67E22",
     "Medium/High ICS-LABA\n+ Add LAMA (tiotropium)\nif uncontrolled",
     "As-needed ICS-formoterol\n→ Refer to specialist\n→ Check adherence + technique",
     "#E67E22", ""),
    (15.50, "STEP 5\nVery Severe /\nRefractory", "#FDEDEC", RED,
     "High-dose ICS-LABA + LAMA\n+ BIOLOGIC THERAPY\n(see biologic table below)",
     "As-needed ICS-formoterol\nMinimize / avoid OCS\n[Bronchial thermoplasty: option]",
     RED, ""),
]

for (yc, step_lbl, bg_c, brd, ctrl, rel, nc, note) in step_data:
    # Step badge
    box(ax, 1.6, yc, 2.5, 1.1, step_lbl,
        bg=brd, border=brd, bold=True, fontsize=9, text_color=WHITE)
    # Controller
    box(ax, 7.2, yc, 8.8, 1.1, "CONTROLLER (Daily)\n" + ctrl,
        bg=bg_c, border=brd, fontsize=7.8)
    # Reliever
    box(ax, 16.5, yc, 8.8, 1.1, "RELIEVER (As-needed)\n" + rel,
        bg=bg_c, border=brd, fontsize=7.8)
    # down arrows between steps
    if yc > 15.5:
        arrow(ax, 1.6, yc - 0.55, 1.6, yc - 1.05, color=brd, lw=2.0)

# "step up" label on left
for yc in [20.35, 18.70, 17.10, 15.50]:
    ax.text(0.35, yc + 0.55, "▲ Step\nUp", fontsize=7, color="#888888",
            ha="center", va="center", rotation=0)

# Step-down annotation
ax.text(0.35, 21.35, "▼ Step\nDown\nif controlled\n3+ months",
        fontsize=6.5, color=GREEN, ha="center", va="center")

divider(ax, 14.85)

# ══════════════════════════════════════════════════════════════════
#   SECTION D  —  BIOLOGICS
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 14.6, 21.4, 0.45,
           "STEP 3b — BIOLOGIC AGENTS  (Step 5 — Severe / Type 2 Asthma)", bg=PURPLE, fontsize=9.5)

bio_data = [
    ("Omalizumab\n(+ biosimilar)\n★ Anti-IgE",         "Elevated IgE\n+ allergic sensitisation", "Allergic\nasthma\n≥6 yrs",  "#F4ECF7", PURPLE),
    ("Mepolizumab\n★ Anti-IL-5",                       "Blood eos\n≥150–300/μL",                 "Eosinophilic\nasthma\n≥6 yrs", "#EBF5FB", "#2980B9"),
    ("Benralizumab\n★ Anti-IL-5Rα",                    "Blood eos\n≥300/μL",                     "Eosinophilic\nasthma\n≥12 yrs","#EBF5FB","#1A5276"),
    ("Dupilumab\n★ Anti-IL-4Rα\n(IL-4 + IL-13)",      "Blood eos ≥150/μL\nOR FeNO ≥25 ppb",     "Type 2\nasthma\n≥6 yrs",       "#E9F7EF", GREEN),
    ("Tezepelumab\n★ Anti-TSLP",                       "Broad — works even\nwithout T2 markers",  "Severe asthma\nincl. non-T2\n≥12 yrs","#FEF9E7",AMBER),
    ("Depemokimab\n★ Anti-IL-5 (NEW)\nEvery 6 months", "Blood eos\n≥300/μL",                     "Eosinophilic\nasthma\n≥12 yrs","#FDEDEC", RED),
]

bx_w  = 3.2
bx_gap = 3.53
bx_start = 1.85
bx_y  = 13.55

for i, (name, marker, age, bg_b, brd_b) in enumerate(bio_data):
    bx = bx_start + i * bx_gap
    box(ax, bx, bx_y, bx_w, 1.8,
        name + "\n─────────\n" + marker + "\n─────────\n" + age,
        bg=bg_b, border=brd_b, fontsize=7.5)

ax.text(11, 12.6, "★ NEW — GINA 2026: Depemokimab added  |  Biosimilar omalizumab added  |  "
        "GLP-1 agonists: potential future role (observational data)",
        ha="center", va="center", fontsize=7.5, color=PURPLE,
        fontstyle="italic")

divider(ax, 12.25)

# ══════════════════════════════════════════════════════════════════
#   SECTION E  —  ACUTE EXACERBATION
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 12.05, 21.4, 0.45,
           "STEP 4 — ACUTE EXACERBATION MANAGEMENT", bg=RED, fontsize=9.5)

# ---- 3 severity columns ----
sev_cols = [
    (4.0,  "MILD – MODERATE\nPEFR >60%",
     "• SpO₂ ≥92%; speaks sentences\n"
     "• SABA q20 min ×3\n"
     "  (or ICS-formoterol — new 2026)\n"
     "• If no improvement in 1–2h:\n"
     "  → Add ipratropium\n"
     "  → Oral prednisolone 30–50 mg\n"
     "• Observe; discharge if PEFR ≥60%",
     LGREEN, GREEN),
    (11.0, "SEVERE\nPEFR 40–60%",
     "• SpO₂ <92%; speaks in words\n"
     "• Nebulised SABA + ipratropium\n"
     "  q20 min ×3\n"
     "• Systemic OCS (IV or oral)\n"
     "• Controlled O₂ → target 93–95%\n"
     "  (give O₂ ONLY if SpO₂ <92%)\n"
     "• Admit if no rapid improvement",
     LORANGE, AMBER),
    (18.0, "LIFE-THREATENING\nPEFR <40% / Silent chest",
     "• ICU admission\n"
     "• IV methylprednisolone\n"
     "• Continuous nebulised SABA\n"
     "• IV MgSO₄ 2 g over 20 min\n"
     "• Heliox (70:30) if available\n"
     "• NIPPV (selected patients)\n"
     "• Intubate if imminent resp. failure\n"
     "  (permissive hypercapnia strategy)",
     LRED, RED),
]

for (bx, title, body, bg_e, brd_e) in sev_cols:
    box(ax, bx, 10.4, 6.8, 3.0,
        title + "\n──────────\n" + body,
        bg=bg_e, border=brd_e, fontsize=7.8)

# Alert: O2 + anaphylaxis
box(ax, 11, 8.65, 20.8, 0.8,
    "⚑  O₂ THERAPY (GINA 2026): Give supplemental O₂ ONLY if SpO₂ <92%  —  Target 93–95% (adults)  /  ≥92% (children ≤5 yrs)\n"
    "⚑  ANAPHYLAXIS + ASTHMA:  Give EPINEPHRINE FIRST  →  then bronchodilators",
    bg="#FDEDEC", border=RED, fontsize=8.5, bold=True, text_color=RED)

divider(ax, 8.1)

# ══════════════════════════════════════════════════════════════════
#   SECTION F  —  DISCHARGE + FOLLOW-UP
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 7.9, 21.4, 0.45,
           "STEP 5 — DISCHARGE CRITERIA & FOLLOW-UP", bg=GREEN, fontsize=9.5)

discharge_items = [
    "PEFR ≥60% (ideally ≥70–80%)", "Symptoms controlled; no nocturnal symptoms",
    "Inhaler technique verified", "Written asthma action plan given",
    "Follow-up within 1–2 weeks",  "Step-up therapy reviewed; OCS course completed"
]
cols_per_row = 3
box_w = 6.6
x_starts = [2.2, 9.0, 15.8]

for i, item in enumerate(discharge_items):
    row_i = i // cols_per_row
    col_i = i  % cols_per_row
    bx = x_starts[col_i]
    by = 7.2 - row_i * 0.65
    box(ax, bx, by, box_w, 0.5, "✓  " + item,
        bg=LGREEN, border=GREEN, fontsize=8.2, ha="center")

divider(ax, 5.85)

# ══════════════════════════════════════════════════════════════════
#   SECTION G  —  MONITORING LOOP
# ══════════════════════════════════════════════════════════════════
header_box(ax, 11, 5.65, 21.4, 0.45,
           "ONGOING MONITORING  (Every Visit)", bg=TEAL, fontsize=9.5)

monitor_items = [
    ("Symptom\nControl", "GINA 4Q tool\nevery visit", LGREY, TEAL),
    ("Spirometry /\nPEFR", "FEV1; reassess\nevery 3–12 months", "#EBF5FB", "#2980B9"),
    ("Inhaler\nTechnique", "Check & correct\nat every visit\n(50% have errors)", LYELLOW, AMBER),
    ("Adherence", "Address barriers;\nsimplify regimen", LGREEN, GREEN),
    ("FeNO", "≥25 ppb = eosinophilic\nInflammation; predicts\nICS response", LPURPLE, PURPLE),
    ("Step\nReview", "Step DOWN if\nwell controlled\n≥3 months", "#E8F8F5", TEAL),
]

mon_x  = [2.0, 5.7, 9.4, 13.1, 16.8, 20.5]
for i, (title, body, bg_m, brd_m) in enumerate(monitor_items):
    box(ax, mon_x[i], 4.8, 3.2, 1.45,
        title + "\n─────\n" + body,
        bg=bg_m, border=brd_m, fontsize=7.7)

# curved "reassess" arrow
ax.annotate("", xy=(0.7, 23.4), xytext=(0.7, 4.5),
            arrowprops=dict(arrowstyle="->", color="#AAAAAA", lw=1.5,
                            connectionstyle="arc3,rad=-0.3"),
            zorder=1)
ax.text(0.1, 14.0, "Reassess\n& adjust\ntherapy",
        fontsize=7.5, color="#888888", ha="center", rotation=90)

divider(ax, 3.65)

# ══════════════════════════════════════════════════════════════════
#   LEGEND
# ══════════════════════════════════════════════════════════════════
legend_items = [
    (NAVY,   "Main pathway"),
    (GREEN,  "Non-pharmacologic / discharge"),
    (AMBER,  "Moderate severity"),
    (RED,    "Severe / warning"),
    (PURPLE, "Biologic therapy"),
    (TEAL,   "Assessment / monitoring"),
]
lx = 1.5
ax.text(lx, 3.4, "LEGEND:", fontsize=8, fontweight="bold", color=DARK)
for i, (col, lbl) in enumerate(legend_items):
    cx = lx + i * 3.4
    rect = FancyBboxPatch((cx, 2.85), 0.35, 0.3,
                          boxstyle="round,pad=0.02",
                          facecolor=col, edgecolor=col, zorder=3)
    ax.add_patch(rect)
    ax.text(cx + 0.5, 3.0, lbl, fontsize=7.5, color=DARK, va="center")

# ── Footer ─────────────────────────────────────────────────────────
footer_rect = FancyBboxPatch((0.15, 0.1), 21.7, 0.55,
                             boxstyle="round,pad=0.02",
                             facecolor=NAVY, edgecolor=NAVY, zorder=3)
ax.add_patch(footer_rect)
ax.text(11, 0.38,
        "Sources: Harrison's Principles of Internal Medicine 22E (2025)  ·  GINA 2026 Strategy Report (May 2026)  ·  "
        "Murray & Nadel's Textbook of Respiratory Medicine  ·  Fishman's Pulmonary Diseases & Disorders     |     Prepared: August 2026",
        ha="center", va="center", fontsize=7.5, color=WHITE, zorder=4)

# ── Key footnotes ─────────────────────────────────────────────────
ax.text(11, 2.35,
        "★ ICS-formoterol (budesonide/formoterol) = preferred reliever at ALL steps (GINA 2026)   "
        "★★ MART = Maintenance And Reliever Therapy (same inhaler for maintenance + rescue)   "
        "AIR = Anti-Inflammatory Reliever strategy",
        ha="center", va="center", fontsize=7.5, color=DARK, fontstyle="italic",
        multialignment="center")

plt.tight_layout(pad=0)
out = "/tmp/workspace/asthma-summary/Asthma_Flowchart.png"
plt.savefig(out, dpi=180, bbox_inches="tight", facecolor="#F8FAFC")
print(f"SAVED: {out}")
import os; print(f"Size: {os.path.getsize(out):,} bytes")

"""
Bronchial Asthma — Interactive Stepwise Management Presentation
python-pptx  |  16:9 widescreen  |  interactive hyperlink navigation
Slides:
  0  Title / Navigation Hub
  1  Overview: Goals + Assessment
  2  Step 1 — Intermittent
  3  Step 2 — Mild Persistent
  4  Step 3 — Moderate Persistent (MART)
  5  Step 4 — Severe
  6  Step 5 — Very Severe / Biologic
  7  Acute Exacerbation Algorithm
  8  Biologic Selection Guide
  9  Monitoring & Step-Down
"""

from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.oxml.ns import qn, nsmap
from pptx.oxml import parse_xml
from pptx.util import Inches, Pt
from lxml import etree
from io import BytesIO
import copy, textwrap

# ── Slide dimensions 16:9 ────────────────────────────────────────
W = Inches(13.333)
H = Inches(7.5)

prs = Presentation()
prs.slide_width  = W
prs.slide_height = H
BLANK = prs.slide_layouts[6]

# ── Colour palette ────────────────────────────────────────────────
NAVY     = RGBColor(0x1A, 0x35, 0x5E)
TEAL     = RGBColor(0x00, 0x7A, 0x87)
GREEN    = RGBColor(0x1E, 0x7A, 0x45)
AMBER    = RGBColor(0xE6, 0x7E, 0x22)
RED      = RGBColor(0xC0, 0x39, 0x2B)
PURPLE   = RGBColor(0x6C, 0x34, 0x83)
BLUE     = RGBColor(0x29, 0x80, 0xB9)
LGREY    = RGBColor(0xF0, 0xF4, 0xF8)
MGREY    = RGBColor(0xD5, 0xE8, 0xF0)
WHITE    = RGBColor(0xFF, 0xFF, 0xFF)
DARK     = RGBColor(0x1C, 0x1C, 0x1C)
LGREEN   = RGBColor(0xE9, 0xF7, 0xEF)
LYELLOW  = RGBColor(0xFE, 0xF9, 0xE7)
LORANGE  = RGBColor(0xFD, 0xF2, 0xE9)
LRED     = RGBColor(0xFD, 0xED, 0xEC)
LPURPLE  = RGBColor(0xF4, 0xEC, 0xF7)
LBLUE    = RGBColor(0xEB, 0xF5, 0xFB)

# step accent colours
STEP_COLORS = {
    1: (TEAL,   RGBColor(0xE0,0xF4,0xF6), "STEP 1"),
    2: (BLUE,   LBLUE,                     "STEP 2"),
    3: (AMBER,  LYELLOW,                   "STEP 3"),
    4: (RGBColor(0xE6,0x7E,0x22), LORANGE, "STEP 4"),
    5: (RED,    LRED,                      "STEP 5"),
}

# ── Helper: add slide ─────────────────────────────────────────────
def new_slide():
    return prs.slides.add_slide(BLANK)

# ── Helper: solid background ──────────────────────────────────────
def set_bg(slide, color: RGBColor):
    bg = slide.background
    fill = bg.fill
    fill.solid()
    fill.fore_color.rgb = color

# ── Helper: rectangle ────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill_color, line_color=None, line_w=Pt(0)):
    from pptx.util import Emu
    shape = slide.shapes.add_shape(
        1,  # MSO_SHAPE_TYPE.RECTANGLE
        x, y, w, h
    )
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = line_w
    else:
        shape.line.fill.background()
    return shape

# ── Helper: rounded rect ─────────────────────────────────────────
def add_rrect(slide, x, y, w, h, fill_color, line_color=None, line_w=Pt(1.5), radius_pct=5):
    """Add a rounded rectangle via XML tweak."""
    shape = slide.shapes.add_shape(5, x, y, w, h)  # 5 = ROUNDED_RECTANGLE
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if line_color:
        shape.line.color.rgb = line_color
        shape.line.width = line_w
    else:
        shape.line.fill.background()
    # set corner rounding
    sp = shape._element
    spPr = sp.find(qn('p:spPr'))
    prstGeom = spPr.find(qn('a:prstGeom'))
    if prstGeom is not None:
        avLst = prstGeom.find(qn('a:avLst'))
        if avLst is None:
            avLst = etree.SubElement(prstGeom, qn('a:avLst'))
        gd = etree.SubElement(avLst, qn('a:gd'))
        gd.set('name', 'adj')
        gd.set('fmla', f'val {radius_pct * 1000}')
    return shape

# ── Helper: textbox ───────────────────────────────────────────────
def add_tb(slide, x, y, w, h, text, size=Pt(11), color=DARK,
           bold=False, align=PP_ALIGN.LEFT, wrap=True,
           italic=False, anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.auto_size = None
    tf.vertical_anchor = anchor
    tf.margin_left  = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top   = Inches(0.03)
    tf.margin_bottom= Inches(0.03)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.size  = size
    r.font.color.rgb = color
    r.font.bold  = bold
    r.font.italic = italic
    r.font.name  = "Calibri"
    return tb, tf

def add_tb_lines(slide, x, y, w, h, lines, default_size=Pt(10),
                 default_color=DARK, anchor=MSO_ANCHOR.TOP, align=PP_ALIGN.LEFT):
    """lines = list of (text, size, color, bold, italic) tuples"""
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.auto_size = None
    tf.vertical_anchor = anchor
    tf.margin_left   = Inches(0.06)
    tf.margin_right  = Inches(0.06)
    tf.margin_top    = Inches(0.04)
    tf.margin_bottom = Inches(0.04)
    first = True
    for line in lines:
        text  = line[0]
        size  = line[1] if len(line) > 1 else default_size
        col   = line[2] if len(line) > 2 else default_color
        bold  = line[3] if len(line) > 3 else False
        ital  = line[4] if len(line) > 4 else False
        if first:
            para = tf.paragraphs[0]
            first = False
        else:
            para = tf.add_paragraph()
        para.alignment = align
        para.space_after  = Pt(2)
        para.space_before = Pt(1)
        run = para.add_run()
        run.text = text
        run.font.size   = size
        run.font.color.rgb = col
        run.font.bold   = bold
        run.font.italic = ital
        run.font.name   = "Calibri"
    return tb, tf

# ── Helper: hyperlink on shape ────────────────────────────────────
def add_hyperlink(shape, slide_index, prs):
    """Add a slide-jump hyperlink to a shape (click action)."""
    target_slide = prs.slides[slide_index]
    rId = shape.part.relate_to(
        target_slide.part,
        'http://schemas.openxmlformats.org/officeDocument/2006/relationships/slide'
    )
    sp = shape._element
    spPr_tag = sp.find(qn('p:spPr'))
    # Build <p:sp><p:nvSpPr><p:cNvPr> click action via hlinkClick
    nvSpPr = sp.find(qn('p:nvSpPr'))
    nvPr   = nvSpPr.find(qn('p:nvPr'))
    if nvPr is None:
        nvPr = etree.SubElement(nvSpPr, qn('p:nvPr'))
    hlinkMouseClick = etree.SubElement(nvPr, qn('p:hlinkMouseClick'))
    hlinkMouseClick.set(qn('r:id'), rId)

# ── Helper: nav button ─────────────────────────────────────────────
def nav_btn(slide, x, y, label, target_idx, bg=NAVY, fg=WHITE, size=Pt(8.5)):
    w, h = Inches(1.35), Inches(0.32)
    shape = add_rrect(slide, x, y, w, h, bg, line_color=None, radius_pct=8)
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    p = tf.paragraphs[0]
    p.alignment = PP_ALIGN.CENTER
    r = p.add_run()
    r.text = label
    r.font.size = size
    r.font.color.rgb = fg
    r.font.bold = True
    r.font.name = "Calibri"
    add_hyperlink(shape, target_idx, prs)
    return shape

# ── Helper: header bar ────────────────────────────────────────────
def header_bar(slide, title, subtitle="", bg=NAVY):
    # full-width bar at top
    add_rect(slide, 0, 0, W, Inches(1.05), bg)
    add_tb(slide, Inches(0.3), Inches(0.05), Inches(10), Inches(0.55),
           title, size=Pt(22), color=WHITE, bold=True, align=PP_ALIGN.LEFT)
    if subtitle:
        add_tb(slide, Inches(0.3), Inches(0.6), Inches(10), Inches(0.38),
               subtitle, size=Pt(10), color=RGBColor(0xB8,0xCC,0xE4),
               align=PP_ALIGN.LEFT, italic=True)

def source_bar(slide):
    add_rect(slide, 0, Inches(7.2), W, Inches(0.3), NAVY)
    add_tb(slide, Inches(0.2), Inches(7.21), Inches(13), Inches(0.25),
           "Sources: Harrison's 22E (2025)  ·  GINA 2026  ·  Murray & Nadel's  ·  Fishman's Pulmonary",
           size=Pt(7), color=RGBColor(0xAA,0xBB,0xCC), align=PP_ALIGN.LEFT)

# ── Helper: step badge ────────────────────────────────────────────
def step_badge(slide, x, y, step_num):
    ac, _, lbl = STEP_COLORS[step_num]
    w, h = Inches(1.1), Inches(1.0)
    shape = add_rrect(slide, x, y, w, h, ac, radius_pct=10)
    add_tb(slide, x, y, w, h,
           f"STEP\n{step_num}", size=Pt(14), color=WHITE, bold=True,
           align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

# ── Helper: info card ────────────────────────────────────────────
def info_card(slide, x, y, w, h, title, body_lines, title_bg=TEAL, body_bg=LGREY, accent=None):
    # title strip
    th = Inches(0.38)
    add_rrect(slide, x, y, w, th, title_bg, radius_pct=5)
    add_tb(slide, x + Inches(0.06), y, w - Inches(0.1), th,
           title, size=Pt(9.5), color=WHITE, bold=True,
           align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)
    # body
    bh = h - th
    add_rrect(slide, x, y + th, w, bh, body_bg, line_color=title_bg, line_w=Pt(1), radius_pct=3)
    line_objs = [(ln, Pt(8.5), DARK, False, False) for ln in body_lines]
    add_tb_lines(slide, x + Inches(0.08), y + th + Inches(0.04),
                 w - Inches(0.12), bh - Inches(0.06), line_objs)

# ══════════════════════════════════════════════════════════════════
#  SLIDE INDEX CONSTANTS (0-based)
# ══════════════════════════════════════════════════════════════════
S_TITLE  = 0
S_ASSESS = 1
S_STEP1  = 2
S_STEP2  = 3
S_STEP3  = 4
S_STEP4  = 5
S_STEP5  = 6
S_EXAC   = 7
S_BIO    = 8
S_MON    = 9
TOTAL    = 10   # slides 0-9

# Pre-create all slides so hyperlinks resolve correctly
slides = [new_slide() for _ in range(TOTAL)]

# ── NAV BAR helper (reusable bottom strip) ────────────────────────
NAV_LABELS = [
    ("🏠 Home",    S_TITLE),
    ("Assess",     S_ASSESS),
    ("Step 1",     S_STEP1),
    ("Step 2",     S_STEP2),
    ("Step 3",     S_STEP3),
    ("Step 4",     S_STEP4),
    ("Step 5",     S_STEP5),
    ("Exacerb.",   S_EXAC),
    ("Biologics",  S_BIO),
    ("Monitor",    S_MON),
]

def add_nav_bar(slide, current_idx):
    # strip background
    add_rect(slide, 0, Inches(6.88), W, Inches(0.32), RGBColor(0x10,0x20,0x40))
    gap = W / TOTAL
    for i, (lbl, tgt) in enumerate(NAV_LABELS):
        x = i * gap + Inches(0.04)
        bg = RGBColor(0x00,0x5F,0x73) if tgt == current_idx else RGBColor(0x10,0x20,0x40)
        nav_btn(slide, x, Inches(6.9), lbl, tgt, bg=bg, size=Pt(7.5))

# ══════════════════════════════════════════════════════════════════
#  SLIDE 0 — TITLE / NAVIGATION HUB
# ══════════════════════════════════════════════════════════════════
sl = slides[S_TITLE]
set_bg(sl, NAVY)

# decorative gradient strip
add_rect(sl, 0, Inches(1.8), W, Inches(0.06), TEAL)
add_rect(sl, 0, Inches(5.9), W, Inches(0.06), TEAL)

# Title text
add_tb(sl, Inches(0.5), Inches(0.25), Inches(12.3), Inches(0.8),
       "BRONCHIAL ASTHMA", size=Pt(38), color=WHITE, bold=True,
       align=PP_ALIGN.CENTER)
add_tb(sl, Inches(0.5), Inches(1.0), Inches(12.3), Inches(0.65),
       "Interactive Stepwise Management Guide", size=Pt(18),
       color=RGBColor(0x7F,0xC4,0xD0), bold=False, align=PP_ALIGN.CENTER)
add_tb(sl, Inches(0.5), Inches(1.5), Inches(12.3), Inches(0.3),
       "Based on  Harrison's 22E (2025)  ·  GINA 2026  ·  Murray & Nadel's  ·  Fishman's",
       size=Pt(9), color=RGBColor(0x88,0xAA,0xBB), align=PP_ALIGN.CENTER, italic=True)

# GINA 2026 alert banner
add_rrect(sl, Inches(1.2), Inches(1.95), Inches(10.9), Inches(0.52),
          RGBColor(0x3D,0x11,0x11), line_color=RED, line_w=Pt(2), radius_pct=5)
add_tb(sl, Inches(1.3), Inches(1.98), Inches(10.7), Inches(0.45),
       "⚑  GINA 2026:  SABA alone NO LONGER preferred at any step  —  "
       "All patients need ICS-containing therapy  —  ICS-formoterol = preferred reliever",
       size=Pt(9.5), color=RGBColor(0xFF,0x88,0x88), bold=True, align=PP_ALIGN.CENTER)

# Navigation tiles (2 rows × 4-5 cols)
hub_items = [
    ("📋  Assessment\n& Control",      S_ASSESS, TEAL,   RGBColor(0xE0,0xF4,0xF6)),
    ("1️⃣  Step 1\nIntermittent",       S_STEP1,  TEAL,   RGBColor(0xE0,0xF4,0xF6)),
    ("2️⃣  Step 2\nMild Persistent",    S_STEP2,  BLUE,   LBLUE),
    ("3️⃣  Step 3\nModerate / MART",    S_STEP3,  AMBER,  LYELLOW),
    ("4️⃣  Step 4\nSevere",             S_STEP4,  RGBColor(0xE6,0x7E,0x22), LORANGE),
    ("5️⃣  Step 5\nVery Severe",        S_STEP5,  RED,    LRED),
    ("🚨  Acute\nExacerbation",         S_EXAC,   RED,    LRED),
    ("💉  Biologic\nSelection",         S_BIO,    PURPLE, LPURPLE),
    ("📈  Monitoring\n& Step-Down",     S_MON,    GREEN,  LGREEN),
]

tile_w = Inches(2.5)
tile_h = Inches(1.0)
cols = 5
gap_x = (W - Inches(0.4) - tile_w * cols) / (cols - 1) + tile_w
row1_y = Inches(2.6)
row2_y = Inches(3.75)

for i, (lbl, tgt, ac, lc) in enumerate(hub_items):
    col_i = i % cols
    row_i = i // cols
    tx = Inches(0.2) + col_i * gap_x
    ty = row1_y if row_i == 0 else row2_y
    shape = add_rrect(sl, tx, ty, tile_w, tile_h, lc, line_color=ac, line_w=Pt(2), radius_pct=8)
    add_tb(sl, tx, ty, tile_w, tile_h, lbl,
           size=Pt(11), color=DARK, bold=True, align=PP_ALIGN.CENTER,
           anchor=MSO_ANCHOR.MIDDLE)
    add_hyperlink(shape, tgt, prs)

# Key goal box
add_rrect(sl, Inches(0.3), Inches(4.95), Inches(12.7), Inches(0.72),
          RGBColor(0x10,0x28,0x4A), line_color=TEAL, line_w=Pt(1.5), radius_pct=5)
add_tb_lines(sl, Inches(0.4), Inches(5.0), Inches(12.5), Inches(0.6), [
    ("GOALS OF THERAPY: ", Pt(9), RGBColor(0x7F,0xC4,0xD0), True, False),
    ("Control symptoms  ·  Prevent exacerbations  ·  Maintain normal lung function  ·  "
     "Normal activity  ·  Minimise medication side-effects  ·  Prevent asthma deaths",
     Pt(8.5), RGBColor(0xCC,0xDD,0xEE), False, False),
])

source_bar(sl)
add_nav_bar(sl, S_TITLE)

# ══════════════════════════════════════════════════════════════════
#  SLIDE 1 — ASSESSMENT & CONTROL
# ══════════════════════════════════════════════════════════════════
sl = slides[S_ASSESS]
set_bg(sl, LGREY)
header_bar(sl, "ASSESSMENT OF ASTHMA CONTROL", "GINA 4-Question Tool + Risk Factor Evaluation", TEAL)

# GINA 4Q table
tbl_shape = sl.shapes.add_table(6, 3, Inches(0.3), Inches(1.15), Inches(6.5), Inches(2.3))
t = tbl_shape.table
t.columns[0].width = Inches(4.0)
t.columns[1].width = Inches(1.25)
t.columns[2].width = Inches(1.25)
hdrs = ["GINA 4-Question Tool  (Past 4 weeks)", "Yes", "No"]
for ci, h in enumerate(hdrs):
    c = t.cell(0, ci)
    c.fill.solid(); c.fill.fore_color.rgb = TEAL
    c.text = h
    r = c.text_frame.paragraphs[0].runs[0]
    r.font.bold = True; r.font.size = Pt(9.5); r.font.color.rgb = WHITE
    r.font.name = "Calibri"

q_rows = [
    "① Daytime asthma symptoms >2×/week?",
    "② Any night waking due to asthma?",
    "③ Reliever medication needed >2×/week?",
    "④ Any activity limitation due to asthma?",
]
for ri, q in enumerate(q_rows, 1):
    row_bg = RGBColor(0xF5,0xFC,0xFC) if ri % 2 == 0 else WHITE
    for ci in range(3):
        c = t.cell(ri, ci)
        c.fill.solid(); c.fill.fore_color.rgb = row_bg
        txt = q if ci == 0 else ("☐" if ci == 1 else "☐")
        c.text = txt
        r = c.text_frame.paragraphs[0].runs[0]
        r.font.size = Pt(9); r.font.name = "Calibri"
        if ci == 0: r.font.color.rgb = DARK
        else: r.font.size = Pt(14); r.font.color.rgb = TEAL

# Merge score row
sc = t.cell(5, 0)
sc.merge(t.cell(5, 2))
sc.fill.solid(); sc.fill.fore_color.rgb = RGBColor(0xD4,0xEF,0xF4)
sc.text = "Score:  0 Yes = Well controlled   |   1–2 Yes = Partly controlled   |   3–4 Yes = Uncontrolled"
r = sc.text_frame.paragraphs[0].runs[0]
r.font.bold = True; r.font.size = Pt(9); r.font.color.rgb = TEAL; r.font.name = "Calibri"

# Severity classification card (right)
info_card(sl, Inches(7.0), Inches(1.15), Inches(6.0), Inches(2.3),
          "SEVERITY CLASSIFICATION  (GINA)",
          ["  Mild      →  Well controlled at Step 1–2",
           "  Moderate  →  Well controlled at Step 3",
           "  Severe    →  Requires Step 4–5 for control",
           "              OR uncontrolled despite Step 4–5"],
          NAVY, LGREY)

# Risk factors card
info_card(sl, Inches(0.3), Inches(3.55), Inches(6.5), Inches(2.75),
          "RISK FACTORS FOR POOR OUTCOMES",
          ["• SABA overuse (>1 canister/month) — marker of poor control",
           "• No ICS / poor adherence / incorrect inhaler technique",
           "• FEV₁ <60% predicted; high bronchodilator reversibility",
           "• Comorbidities: obesity, rhinosinusitis, GERD, depression, OSA",
           "• Smoking, occupational exposures, indoor allergens",
           "• Blood eosinophilia / elevated FeNO",
           "• History of ≥1 severe exacerbation in past year"],
          RED, LRED)

# Check-before-step-up card
info_card(sl, Inches(7.0), Inches(3.55), Inches(6.0), Inches(2.75),
          "✓  CHECK BEFORE STEPPING UP",
          ["✓  Inhaler technique correct? (errors in ~50%)",
           "✓  Adherence adequate?",
           "✓  Triggers identified & removed?",
           "✓  Comorbidities treated?",
           "✓  Correct diagnosis (not vocal cord, COPD)?"],
          GREEN, LGREEN)

source_bar(sl)
add_nav_bar(sl, S_ASSESS)

# ══════════════════════════════════════════════════════════════════
#  SLIDES 2–6 — STEPWISE TREATMENT (one slide per step)
# ══════════════════════════════════════════════════════════════════

STEP_DATA = {
    1: {
        "slide_idx": S_STEP1,
        "title": "STEP 1 — INTERMITTENT ASTHMA",
        "subtitle": "Symptoms ≤2×/month  |  No night waking  |  Normal lung function",
        "track1_ctrl": ["No daily controller required\n(Anti-Inflammatory Reliever — AIR — track)"],
        "track1_rel":  ["★ As-needed low-dose ICS-formoterol\n   (budesonide/formoterol)  ← PREFERRED",
                        "   OR  ICS-SABA combination inhaler  (new GINA 2026)",
                        "   ⚠  SABA monotherapy ALONE no longer recommended"],
        "track2_ctrl": ["Low-dose ICS daily (daily controller track)"],
        "track2_rel":  ["As-needed SABA  (salbutamol)\n(acceptable if ICS-formoterol unavailable)"],
        "notes":       ["AIR = Anti-Inflammatory Reliever strategy",
                        "ICS-SABA added at Step 1 as GINA 2026 new option",
                        "SABA alone → no anti-inflammatory protection",
                        "LTRA (montelukast): alternative — ⚠ FDA black-box (suicidal ideation)"],
        "ac": TEAL,
        "lc": RGBColor(0xE0,0xF4,0xF6),
    },
    2: {
        "slide_idx": S_STEP2,
        "title": "STEP 2 — MILD PERSISTENT ASTHMA",
        "subtitle": "Symptoms >2×/month but <daily  |  Risk of exacerbations present",
        "track1_ctrl": ["Low-dose ICS daily\n(e.g., budesonide 200–400 mcg/day)"],
        "track1_rel":  ["★ As-needed low-dose ICS-formoterol  ← PREFERRED",
                        "   OR  As-needed SABA + concurrent ICS"],
        "track2_ctrl": ["LTRA (montelukast) — alternative to ICS\n⚠ FDA black-box warning: neuropsychiatric events"],
        "track2_rel":  ["As-needed SABA"],
        "notes":       ["Low-dose ICS: budesonide ≤400 mcg/day (adults)",
                        "Fluticasone propionate ≤250 mcg/day equivalent",
                        "ICS-formoterol as reliever reduces exacerbations vs SABA alone",
                        "Address modifiable risk factors at every visit"],
        "ac": BLUE,
        "lc": LBLUE,
    },
    3: {
        "slide_idx": S_STEP3,
        "title": "STEP 3 — MODERATE PERSISTENT ASTHMA  (MART Strategy)",
        "subtitle": "Daily symptoms  |  FEV₁ 60–80% predicted  |  Step up from Step 2",
        "track1_ctrl": ["Low-dose ICS-LABA daily  ← PREFERRED\n"
                        "e.g., budesonide/formoterol 160/4.5 mcg  1–2 puffs BD"],
        "track1_rel":  ["★★ MART Strategy (same inhaler for maintenance + rescue)\n"
                        "   ICS-formoterol as-needed  IN ADDITION to daily ICS-formoterol",
                        "   → Reduces exacerbations vs fixed-dose + SABA",
                        "   ★ MART = Maintenance And Reliever Therapy"],
        "track2_ctrl": ["Medium-dose ICS daily (alternative)\nOR  Low-dose ICS + LTRA"],
        "track2_rel":  ["As-needed SABA (if not on MART)"],
        "notes":       ["Medium ICS dose: budesonide 400–800 mcg/day (adults)",
                        "MART evidence strongest with budesonide/formoterol",
                        "Formoterol's rapid onset makes it suitable as reliever",
                        "FeNO ≥25 ppb supports eosinophilic inflammation → ICS responsive"],
        "ac": AMBER,
        "lc": LYELLOW,
    },
    4: {
        "slide_idx": S_STEP4,
        "title": "STEP 4 — SEVERE ASTHMA",
        "subtitle": "Uncontrolled on Step 3  |  Confirm adherence, technique, comorbidities first",
        "track1_ctrl": ["Medium/High-dose ICS-LABA daily  ← PREFERRED\n"
                        "e.g., budesonide/formoterol 320/9 mcg or fluticasone/salmeterol 250/50 mcg"],
        "track1_rel":  ["As-needed ICS-formoterol  (MART if on budesonide/formoterol)",
                        "OR  As-needed SABA"],
        "track2_ctrl": ["Add-on LAMA (tiotropium Respimat)\n"
                        "if uncontrolled on ICS-LABA alone\n"
                        "→ Triple therapy (ICS-LABA-LAMA)"],
        "track2_rel":  ["Add-on LTRA or theophylline if needed\n"
                        "(step 4 adjunct; limited role)"],
        "notes":       ["High ICS dose: budesonide >800 mcg/day (adults)",
                        "Triple therapy reduces exacerbations vs ICS-LABA",
                        "  BUT less effective than biologics",
                        "Refer to respiratory specialist",
                        "Consider FeNO, blood eosinophils, IgE for biologic eligibility"],
        "ac": RGBColor(0xE6,0x7E,0x22),
        "lc": LORANGE,
    },
    5: {
        "slide_idx": S_STEP5,
        "title": "STEP 5 — VERY SEVERE / REFRACTORY ASTHMA",
        "subtitle": "Uncontrolled on Step 4-5  |  5–10% of all asthma patients  |  ~50% have eosinophilic inflammation",
        "track1_ctrl": ["High-dose ICS-LABA + LAMA (triple therapy)\n"
                        "+ BIOLOGIC THERAPY  ← mainstay of Step 5"],
        "track1_rel":  ["As-needed ICS-formoterol",
                        "MINIMIZE oral corticosteroids — only if all else fails",
                        "Cumulative OCS toxicity: T2DM, osteoporosis, cataracts, adrenal suppression"],
        "track2_ctrl": ["Macrolide (azithromycin) — neutrophilic/non-eosinophilic subset\n"
                        "Low-dose maintenance OCS — last resort only"],
        "track2_rel":  ["Bronchial thermoplasty\n"
                        "(bronchoscopic; reduces airway smooth muscle mass)\n"
                        "Selected patients at specialist centres"],
        "notes":       ["Definition: uncontrolled despite Step 4–5 after addressing adherence,",
                        "  inhaler technique, comorbidities, and triggers",
                        "Biologics: see Biologic Selection slide",
                        "IV magnesium / OCS for severe exacerbations",
                        "Dupilumab also approved in COPD + eos + exacerbations"],
        "ac": RED,
        "lc": LRED,
    },
}

for step_num, data in STEP_DATA.items():
    sl = slides[data["slide_idx"]]
    ac = data["ac"]
    lc = data["lc"]
    set_bg(sl, LGREY)
    header_bar(sl, data["title"], data["subtitle"], ac)

    # Step badge
    step_badge(sl, Inches(12.15), Inches(0.05), step_num)

    # --- Track layout -----------------------------------------------
    # Track 1 (Preferred)
    add_rrect(sl, Inches(0.25), Inches(1.15), Inches(6.25), Inches(0.32),
              ac, radius_pct=5)
    add_tb(sl, Inches(0.3), Inches(1.15), Inches(6.1), Inches(0.32),
           "TRACK 1  —  PREFERRED  (GINA 2026)",
           size=Pt(9), color=WHITE, bold=True)

    info_card(sl, Inches(0.25), Inches(1.48), Inches(3.0), Inches(2.1),
              "CONTROLLER (Daily)",
              data["track1_ctrl"], ac, lc)
    info_card(sl, Inches(3.5), Inches(1.48), Inches(3.0), Inches(2.1),
              "RELIEVER (As-needed)",
              data["track1_rel"], ac, lc)

    # --- Track 2 (Alternative) ---------------------------------------
    add_rrect(sl, Inches(0.25), Inches(3.7), Inches(6.25), Inches(0.32),
              RGBColor(0x55,0x55,0x55), radius_pct=5)
    add_tb(sl, Inches(0.3), Inches(3.7), Inches(6.1), Inches(0.32),
           "TRACK 2  —  ALTERNATIVE",
           size=Pt(9), color=WHITE, bold=True)

    info_card(sl, Inches(0.25), Inches(4.03), Inches(3.0), Inches(2.0),
              "ALTERNATIVE CONTROLLER",
              data["track2_ctrl"], RGBColor(0x55,0x55,0x55), WHITE)
    info_card(sl, Inches(3.5), Inches(4.03), Inches(3.0), Inches(2.0),
              "ALTERNATIVE RELIEVER",
              data["track2_rel"], RGBColor(0x55,0x55,0x55), WHITE)

    # --- Key notes panel (right side) --------------------------------
    info_card(sl, Inches(6.85), Inches(1.15), Inches(6.2), Inches(5.45),
              "📌  KEY NOTES",
              data["notes"], NAVY, LGREY)

    # --- Navigation buttons ------------------------------------------
    # Prev / Next step arrows
    if step_num > 1:
        prev_idx = data["slide_idx"] - 1
        nav_btn(sl, Inches(0.25), Inches(6.55), "◀ Step " + str(step_num-1), prev_idx,
                bg=RGBColor(0x33,0x55,0x77), fg=WHITE, size=Pt(8))
    if step_num < 5:
        next_idx = data["slide_idx"] + 1
        nav_btn(sl, Inches(1.75), Inches(6.55), "Step " + str(step_num+1) + " ▶", next_idx,
                bg=ac, fg=WHITE, size=Pt(8))

    # Quick-jump buttons
    nav_btn(sl, Inches(4.5),  Inches(6.55), "🚨 Exacerbation", S_EXAC,  bg=RED,    fg=WHITE, size=Pt(8))
    nav_btn(sl, Inches(6.0),  Inches(6.55), "💉 Biologics",    S_BIO,   bg=PURPLE, fg=WHITE, size=Pt(8))
    nav_btn(sl, Inches(7.5),  Inches(6.55), "📈 Monitor",      S_MON,   bg=GREEN,  fg=WHITE, size=Pt(8))
    nav_btn(sl, Inches(9.0),  Inches(6.55), "📋 Assess",       S_ASSESS,bg=TEAL,   fg=WHITE, size=Pt(8))
    nav_btn(sl, Inches(10.5), Inches(6.55), "🏠 Home",         S_TITLE, bg=NAVY,   fg=WHITE, size=Pt(8))

    source_bar(sl)
    add_nav_bar(sl, data["slide_idx"])

# ══════════════════════════════════════════════════════════════════
#  SLIDE 7 — ACUTE EXACERBATION ALGORITHM
# ══════════════════════════════════════════════════════════════════
sl = slides[S_EXAC]
set_bg(sl, LGREY)
header_bar(sl, "ACUTE EXACERBATION MANAGEMENT", "PEFR-based severity assessment  |  GINA 2026 updated O₂ targets", RED)

# O2 alert
add_rrect(sl, Inches(0.25), Inches(1.12), Inches(12.85), Inches(0.5),
          RGBColor(0x3D,0x11,0x11), line_color=RED, line_w=Pt(2), radius_pct=5)
add_tb(sl, Inches(0.3), Inches(1.14), Inches(12.7), Inches(0.44),
       "⚑  O₂ ONLY if SpO₂ <92%  —  Target 93–95% (adults)  /  ≥92% (children ≤5 yrs)     "
       "⚑  ANAPHYLAXIS + ASTHMA:  Give EPINEPHRINE first, THEN bronchodilators",
       size=Pt(9.5), color=RGBColor(0xFF,0x88,0x88), bold=True, align=PP_ALIGN.CENTER)

# Three severity columns
SEV_COLS = [
    ("MILD – MODERATE\nPEFR >60%", GREEN, LGREEN,
     ["SpO₂ ≥92%  |  Speaks in sentences",
      "",
      "① SABA 4–8 puffs (or 2.5 mg neb)",
      "   q20 min × 3  (or ICS-formoterol)",
      "② Assess PEFR after 1 h",
      "③ If improving: continue SABA PRN",
      "④ If not improving:",
      "    → Add ipratropium 4 puffs",
      "    → Oral prednisolone 30–50 mg",
      "",
      "DISCHARGE if PEFR ≥60%:",
      "✓ Written action plan",
      "✓ Follow-up in 1–2 weeks",
      "✓ Step-up therapy reviewed"]),
    ("SEVERE\nPEFR 40–60%", AMBER, LORANGE,
     ["SpO₂ <92%  |  Speaks in words",
      "Accessory muscle use",
      "",
      "① Nebulised SABA + ipratropium",
      "   q20 min × 3",
      "② IV or oral OCS (early)",
      "③ Controlled O₂ → target 93–95%",
      "④ PEFR reassessment in 1 h",
      "⑤ If no rapid improvement → ADMIT",
      "",
      "IN HOSPITAL:",
      "• Continuous neb. bronchodilators",
      "• IV methylprednisolone",
      "• Monitor SpO₂, PEFR, blood gases"]),
    ("LIFE-THREATENING\nPEFR <40%  /  Silent chest", RED, LRED,
     ["Signs: Silent chest, cyanosis,",
      "  altered consciousness, bradycardia",
      "",
      "→ ICU ADMISSION",
      "",
      "① IV methylprednisolone 125 mg",
      "② Continuous nebulised SABA",
      "③ IV MgSO₄  2g over 20 min",
      "④ Heliox 70:30  (if available)",
      "⑤ NIPPV (selected patients)",
      "",
      "If respiratory failure imminent:",
      "• Intubate & ventilate",
      "• Permissive hypercapnia",
      "• Low VT 5–7 mL/kg, long exp. time",
      "• Avoid auto-PEEP"]),
]

col_w = Inches(4.15)
for i, (title, ac_e, lc_e, lines) in enumerate(SEV_COLS):
    cx = Inches(0.25) + i * Inches(4.36)
    add_rrect(sl, cx, Inches(1.7), col_w, Inches(0.4), ac_e, radius_pct=5)
    add_tb(sl, cx + Inches(0.05), Inches(1.7), col_w - Inches(0.1), Inches(0.4),
           title, size=Pt(9.5), color=WHITE, bold=True,
           align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    add_rrect(sl, cx, Inches(2.11), col_w, Inches(4.55), lc_e,
              line_color=ac_e, line_w=Pt(1.5), radius_pct=3)
    line_objs = [(ln, Pt(8.5), DARK, False, False) for ln in lines]
    add_tb_lines(sl, cx + Inches(0.08), Inches(2.15),
                 col_w - Inches(0.12), Inches(4.48), line_objs)

nav_btn(sl, Inches(0.25), Inches(6.6), "🏠 Home",   S_TITLE, bg=NAVY, size=Pt(8))
nav_btn(sl, Inches(1.75), Inches(6.6), "💉 Biologics", S_BIO, bg=PURPLE, size=Pt(8))
nav_btn(sl, Inches(3.25), Inches(6.6), "📈 Monitor", S_MON, bg=GREEN, size=Pt(8))

source_bar(sl)
add_nav_bar(sl, S_EXAC)

# ══════════════════════════════════════════════════════════════════
#  SLIDE 8 — BIOLOGIC SELECTION
# ══════════════════════════════════════════════════════════════════
sl = slides[S_BIO]
set_bg(sl, LGREY)
header_bar(sl, "BIOLOGIC THERAPY SELECTION GUIDE", "Step 5 — Severe / Refractory Asthma  |  GINA 2026", PURPLE)

bio_tbl = sl.shapes.add_table(8, 5,
                               Inches(0.25), Inches(1.15),
                               Inches(12.85), Inches(5.0))
t = bio_tbl.table
t.columns[0].width = Inches(2.2)
t.columns[1].width = Inches(2.0)
t.columns[2].width = Inches(3.2)
t.columns[3].width = Inches(1.5)
t.columns[4].width = Inches(3.95)

hdrs = ["Biologic  (Target)", "Mechanism", "Biomarker / Indication", "Age", "Notes"]
for ci, h in enumerate(hdrs):
    c = t.cell(0, ci)
    c.fill.solid(); c.fill.fore_color.rgb = PURPLE
    c.text = h
    r = c.text_frame.paragraphs[0].runs[0]
    r.font.bold = True; r.font.size = Pt(9.5); r.font.color.rgb = WHITE; r.font.name = "Calibri"

bio_rows = [
    ("Omalizumab\n(Anti-IgE)\n+ biosimilar available",
     "Binds free IgE →\n↓ mast cell / basophil\nactivation",
     "Elevated serum IgE\n+ allergen sensitisation\n(allergic asthma)",
     "≥6 yrs",
     "SC monthly or bimonthly\nFor allergic/atopic phenotype",
     RGBColor(0xF4,0xEC,0xF7)),
    ("Mepolizumab\n(Anti-IL-5)",
     "Blocks IL-5 →\n↓ eosinophil maturation\n& survival",
     "Blood eos ≥150–300/μL\n(≥300 for best response)\nEosinophilic asthma",
     "≥6 yrs",
     "SC monthly\nAlso: EGPA, HES",
     LBLUE),
    ("Benralizumab\n(Anti-IL-5Rα)",
     "Binds IL-5Rα →\nDirect eosinophil\ndepletion (ADCC)",
     "Blood eos ≥300/μL\nEosinophilic asthma",
     "≥12 yrs",
     "SC Q4w × 3, then Q8w\nFaster eosinophil depletion\nvs mepolizumab",
     LGREEN),
    ("Dupilumab\n(Anti-IL-4Rα)\n[IL-4 + IL-13 blockade]",
     "Blocks shared IL-4Rα\n→ ↓ type-2 airway\ninflammation",
     "Blood eos ≥150/μL\nOR FeNO ≥25 ppb\nType 2 (T2-high) asthma",
     "≥6 yrs",
     "SC biweekly or monthly\nAlso approved: COPD+eos,\natopic dermatitis, CRSwNP",
     LYELLOW),
    ("Tezepelumab\n(Anti-TSLP)",
     "Blocks TSLP (upstream\nalarmins) → broad\nT2 + non-T2 effects",
     "BROADEST INDICATION\nWorks even without\nelevated T2 biomarkers",
     "≥12 yrs",
     "SC monthly\nOnly biologic for non-T2\nor mixed-endotype asthma",
     LORANGE),
    ("Depemokimab\n(Anti-IL-5)\n★ NEW — GINA 2026",
     "Ultra-long-acting anti-IL-5\n↓ eosinophil\nmaturation & survival",
     "Blood eos ≥300/μL\nSevere eosinophilic asthma\nAlso: CRSwNP (≥18 yrs)",
     "≥12 yrs\n(CRSwNP\n≥18 yrs)",
     "SC every 6 MONTHS\n(half-yearly dosing)\nNew addition in GINA 2026",
     LRED),
]

alt_fills = [RGBColor(0xF4,0xEC,0xF7), LBLUE, LGREEN, LYELLOW, LORANGE, LRED]
for ri, (name, mech, marker, age, notes, bg_r) in enumerate(bio_rows, 1):
    for ci, txt in enumerate([name, mech, marker, age, notes]):
        c = t.cell(ri, ci)
        c.fill.solid(); c.fill.fore_color.rgb = bg_r
        c.text = txt
        r = c.text_frame.paragraphs[0].runs[0]
        r.font.size = Pt(8.5); r.font.name = "Calibri"
        if ci == 0: r.font.bold = True; r.font.color.rgb = PURPLE
        else: r.font.color.rgb = DARK

# last row — selection hint
for ci in range(5):
    t.cell(7, ci).fill.solid()
    t.cell(7, ci).fill.fore_color.rgb = RGBColor(0x1A,0x35,0x5E)
t.cell(7, 0).merge(t.cell(7, 4))
t.cell(7, 0).text = ("SELECTION HINT:  Allergic → Omalizumab  |  Blood eos high → Mepolizumab / Benralizumab / Depemokimab  |  "
                     "T2-high (eos OR FeNO) → Dupilumab  |  Non-T2 or mixed → Tezepelumab")
r = t.cell(7, 0).text_frame.paragraphs[0].runs[0]
r.font.bold = True; r.font.size = Pt(8.5); r.font.color.rgb = WHITE; r.font.name = "Calibri"

nav_btn(sl, Inches(0.25),  Inches(6.57), "◀ Step 5",    S_STEP5, bg=RED,    size=Pt(8))
nav_btn(sl, Inches(1.75),  Inches(6.57), "🚨 Exacerb.", S_EXAC,  bg=RED,    size=Pt(8))
nav_btn(sl, Inches(3.25),  Inches(6.57), "📈 Monitor",  S_MON,   bg=GREEN,  size=Pt(8))
nav_btn(sl, Inches(11.6),  Inches(6.57), "🏠 Home",     S_TITLE, bg=NAVY,   size=Pt(8))

source_bar(sl)
add_nav_bar(sl, S_BIO)

# ══════════════════════════════════════════════════════════════════
#  SLIDE 9 — MONITORING & STEP-DOWN
# ══════════════════════════════════════════════════════════════════
sl = slides[S_MON]
set_bg(sl, LGREY)
header_bar(sl, "ONGOING MONITORING & STEP-DOWN", "Every visit checklist  |  When & how to step down", GREEN)

# 6 monitoring cards in 2 rows × 3 cols
mon_cards = [
    ("📋  Symptom Control", GREEN, LGREEN,
     ["GINA 4-question tool every visit",
      "Well controlled ≥3 months → consider step-down",
      "Partly controlled → check technique, adherence",
      "Uncontrolled → step up after addressing barriers"]),
    ("🌬  Spirometry / PEFR", BLUE, LBLUE,
     ["FEV₁ at diagnosis, then annually",
      "Reassess after 3–6 months of new therapy",
      "PEFR diaries for self-monitoring (severe asthma)",
      "FEV₁ <60% predicted = high-risk marker"]),
    ("💨  Inhaler Technique", TEAL, RGBColor(0xE0,0xF4,0xF6),
     ["Check technique at every single visit",
      "Poor technique found in up to 50% of 'refractory'",
      "pMDI: slow deep breath, 5 s hold; shake suspensions",
      "DPI: fast forceful breath; spacer with pMDI for children/elderly"]),
    ("✅  Adherence", AMBER, LYELLOW,
     ["Identify and address barriers",
      "Simplify regimen (MART reduces inhaler count)",
      "Assess prescription refill rates",
      "Poor adherence → cause of apparent refractory asthma"]),
    ("🔬  Biomarker Review", PURPLE, LPURPLE,
     ["FeNO ≥25 ppb → eosinophilic inflammation",
      "  → predicts ICS response",
      "Blood eosinophils ≥300/μL → biologic eligibility",
      "IgE level → omalizumab eligibility"]),
    ("⬇  Step-Down Protocol", GREEN, LGREEN,
     ["Step down only if well controlled ≥3 months",
      "Do NOT step down during: pregnancy, allergy season,",
      "  active infection, recent exacerbation",
      "Reduce ICS dose by 25–50% per step",
      "Discontinue LABA before reducing ICS (if possible)"]),
]

card_w = Inches(4.1)
card_h = Inches(2.4)
gap_x  = Inches(0.23)
start_x = Inches(0.25)
row1_y  = Inches(1.2)
row2_y  = Inches(3.8)

for i, (title, ac_m, lc_m, lines) in enumerate(mon_cards):
    col_i = i % 3
    row_i = i // 3
    cx = start_x + col_i * (card_w + gap_x)
    cy = row1_y if row_i == 0 else row2_y
    info_card(sl, cx, cy, card_w, card_h, title, lines, ac_m, lc_m)

nav_btn(sl, Inches(0.25),  Inches(6.6), "🏠 Home",   S_TITLE, bg=NAVY,   size=Pt(8))
nav_btn(sl, Inches(1.75),  Inches(6.6), "📋 Assess", S_ASSESS,bg=TEAL,   size=Pt(8))
nav_btn(sl, Inches(3.25),  Inches(6.6), "💉 Biologics", S_BIO, bg=PURPLE, size=Pt(8))
nav_btn(sl, Inches(4.75),  Inches(6.6), "🚨 Exacerb.", S_EXAC, bg=RED,   size=Pt(8))

source_bar(sl)
add_nav_bar(sl, S_MON)

# ══════════════════════════════════════════════════════════════════
#  SAVE
# ══════════════════════════════════════════════════════════════════
out = "/tmp/workspace/asthma-summary/Asthma_Stepwise_Management.pptx"
buf = BytesIO()
prs.save(buf)
with open(out, "wb") as f:
    f.write(buf.getvalue())

import os
print(f"SAVED: {out}")
print(f"Size:  {os.path.getsize(out):,} bytes")
print(f"Slides: {len(prs.slides)}")