Asthma

Click to edit Master subtitle style Zain Cawasji 5/23/12

A 26 year old lady with a history of asthma presents to the ER with a 3 day history of progressive wheezing and shortness of breath after an upper respiratory tract infection. She is taking Salbutamol inhalers and over the counter medication for her cold. Her respiratory rate is 28/min, and her pulse is 110/min; she is afebrile. Her right nasal turbinate is edematous and erythematous. On examination there is bilateral wheezing but no crackles. Supplemental Oxygen is given. How would you manage this patient?

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Objectives

Definition. Pathophysiology. Clinical Features. Objective measures of severity assessment. Management.

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Asthma
Asthma is a disease characterised by inflammatory hyperactivity of the respiratory tree to various stimuli., resulting in reversible airway obstruction. A combination of mucosal inflammation, bronchial muscle constriction, and an excessive secretion of viscous mucus causing mucus plugs produce bronchial obstruction. The bronchial hyper reactivity occurs in an episodic pattern with interspersed normal airway tone. Asthma can occur at any age but is most commonly seen in young people, half of whom outgrow their asthma by adulthood.
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Etiology

Genetic. Environmental factors. Occupational exposure. Cold air and exercise. Diet. Emotions.
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Drugs.

Allergic

Immediate Asthma. Airflow limitation begins in

minutes, reaches its maximum in 15-20 min and subsides within an hour.

Dual and late phase reactions. Following an

immediate reaction, many patients develop a prolonged and sustained attack to airflow limitation that responds poorly to bronchodilators. Upto several weeks after exposure, the airways are hyperresponsive.

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Pathophysiology

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Symptoms

Intermittent dyspnea Wheeze Cough Sputum

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History

Precipitating Factors:

Cold air, exercise, emotions, allergens (dust mite, pollen, animal fur), infection, drugs (aspirin, NSAIDs, beta blockers).

Diurnal Variation: Exercise:

In symptoms or peak flow.

Amount tolerated. Nights per week?

Disturbed sleep: Acid Reflux.

Other Atopic diseases:

history.

Eczema, hay fever, allergy, family

The 5/23/12 Home: Pets, carpets, feather pillows, dust.

Signs

Tachypnea. Audible wheeze. Hyperinflated chest. Diminished air entry. Hyperresonant percussion note. Wheezing on auscultation.

Severe attack: inability to complete sentences, pulse >110/min, RR >25/min, PEF 33-55% of predicted.
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Investigations

Peak expiratory flow rate. Exercise tests. Histamine or methacholine bronchial provocation test. Corticosteroid trial. Blood and sputum tests.
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Cheast xray.

Management
Aims to:

Abolish symptoms. Restore best possible lung functions. Reduce the risk of severe attacks. Enable normal child growth. Reduce absence from work or school.

By:

Patient 5/23/12 and family education.

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