asthma - zain cawasji

7/31/2019 Asthma - Zain Cawasji

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5/23/12

AsthmaZain Cawasji


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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 takingSalbutamol 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 occurat 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.

Drugs.


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Allergic

Immediate Asthma. Airflow limitation begins inminutes, reaches its maximum in 15-20 min and subsides within an

hour.

Dual and late phase reactions. Following animmediate reaction, many patients develop a prolonged and

sustained attack to airflow limitation that responds poorly tobronchodilators. 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: In symptoms or peak flow. Exercise: Amount tolerated.

Disturbed sleep: Nights per week?

Acid Reflux.

Other Atopic diseases: Eczema, hay fever, allergy, familyhistory.

The Home: Pets, carpets, feather pillows, dust.


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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.

Cheast xray.


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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 and family education.


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asthma - zain cawasji

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