Asthma Flashcards
Definition of asthma
Heterogeneous disease characterized by chronic airway inflammation with history symptoms ( cough, breathlessness, wheezes, chest tightness ) and variable expiratory airway limitation
Which part of respiration is affected in asthma,
Inspiration or expiration
Expiration
What criteria allow for diagnosis of asthma
More than one type of these symptoms( wheeze, Shortness of breath, Cough, Chest tightness )
Symptoms worse at night or early morning
Vary over time and in intensity
Trigger of symptoms by viral infection, exercise , allergen, weather changes, laughter , irritants ( car fumes, smoke , strong smells
Symptoms that decrease diagnosis of asthma
isolated cough wiith no other respiratory symptom
Chronic production of sputum
Shortness of breath with dizziness , light headedness, peripheral tingling
Chest pain
Exercise induced Dyspnea wirh noisy inspiration stridor
Common trigger of asthma attack
viral infection URTI
Pollen
Animal dander
Dust
Smoke / fumes
Strong scent
Hoist dust mite , mold
Exercise
Strong emotions
Changes in temperature
Weather changes
Stress
Occupational exposure
Why asthma worsens at night
Because of cortisol level low at night which means that the body can’t fight inflammation as well as during the day when cortisol high
Factors that increase prevalence of asthma
parental history of asthma or atopy
Parental smoking - maternal smoking in pregnancy
Sensitization I to aeroallergens
Widespread use of antibiotic
Western lifestyle
Urban environnement
Diet
Factors that decrease prevalence of asthma
Farm environment
Older siblings
Viral infection
Earl attendance of day care during first 6 months of life
Tuberculosis
Symptoms pattern possible in asthma
Episodic or continuous
Seasonal or perennial
Nocturnal
Read pathophysiology of asthma
Okk
Findings of examination in asthma
Normal if no exacerbation
Lung hyperinflation
Wheezing
Allergic dx (rhinitis , sinusitis, nasal polyps , eczema)
Lung function test to demonstrated airflow limitation in asthma
Spirometry
Peak expiratory flow rate
Comorbidities in asthma
Sinusitis
Rhinosinusitis
COPD
GERD
OSA
How to diagnose asthma
Hx of symptoms
Examination
Lung function test (spirometry , PEF)
Comorbidities assessment
Broncho provocation test
Allergic states tests
FENO
FBC
CxR
Medications/activity used in bronchoprovocation test
Methcholine
Histamine challenge
Post exertion state
Differential of wheezing
COPD
Bronchiolitis
Cystic fibrosis
Foreign body aspiration
Thromboembolism
Bronchiectasis
Bronchopulmonary aspergillosis
Pulmonary edema
Psychogenic wheezing
LVHF
Differentials of episodic dyspnea
COPD
CAD
Congestive heart failure
Pulmonary emboli
Recurrent GERD
Carcinoid syndrome
Differential cough
bronchiectasis
Cystic fibrosis
Pneumonia
Rhinitis
Bronchitis
Sinusitis
Diffuse pulmonary fibrosis ]
Management classification of asthma
Acute (Mild, Moderate, Severe, Life threatening )
chronic (Intermittent ,Persistent )
Goal of management
Control of symptoms
Risk reduction
Non pharmacological management of asthma
education
Complice ce for medication
Asthma action pl’an
Avoid précipitants
Proper inhaler techniques
Thermal bronchoplasty
Mange ment when symptoms less than twice a month
Controller and reliever -> as needed low dose ICS - formoterol
Management when Symptoms twice or more a month but less than daily
Controller -> daily low dose ICS or as needed low dose ICS - formoterol
Reliever -> as needed low dose ICS-formoterol
Management when Symptoms most days or waking with asthma once a week or more
Controller => low dose ICS-LABA
Reliever => as needed low dose ICS-formoterol
Management when Symptoms most days , or waking with asthma once or more a week and low une function
Controller => medium dose ICS-LABA
Reliever => as needed low dose ICS-formoterol
Management when severest form of asthma
High dose ICS -LABA
Reliever -> as needed low dose ICS-formoterol
Risk factors for severe asthma
non compliance
Never used ICS
Psychosocial factors
Dysfunctional breathing (Vocal cord dysfunction )
Allergy
Comorbidities
Tobacco smoke. / environemental pollution
ABPA
Patients at risk of asthma related death
history of near fats asthma with intubation and ventilation
Hospitalization or ER for asthma in last 12 months
Not using
ICS , poor adherence with ICS
Using or recently stopped using OCS
Overusing SABA
Lack of written asthma action plan
Hx of psychiatric dx or psychosocial problems
Confirmed food allergy in patient
What is considered severe asthma
asthma that requires treatment with high dose inhaled corticosteroids plus a second controller to prevent uncontrolled asthma or remains uncontrolled despite therapy
How to evaluate acute asthma
• ABC
◦ Airwy
◦ Breathing
◦ Circulation
• Quick hx
• Examination
• Acute asthma severity
• Differential diagnosis ?
• SPO2 , ABGs PEFR / spirometry
• K+, RBS/FBS
• CxR
Signs of mild or moderate asthma
• talks in phrases
• Prefer sitting to lying
• Not agitated
• Increased RR
• Accessory muscles not used
• Pulse rate 100-120bpm
• O2 saturation 90-95%
• PEF >50%
Management of mild moderate asthma
SABA
Ipratropium bromide
O2 maintenance and control
Oral corticosteroids
Saturation 93-95%
Signs of severe asthma
talks in words
Sits hunched forwards
Agitated
RR more than 30/min
Accessory muscles being used
PR >120 bpm
O2 saturation <90%
PEF < 50%
Management of severe asthma
SABA
Ipratroprium bromide
O2 maintenance
93-95% saturation
Oral or IV corticosteroids
IV magnesium
High dose ICS
Criteria for intubation in acute asthma
cardiac arrest
Respiratory arrest
Altered mental status
Progressive exhaustion
Silent chest
Severe hypoxia with maximal oxygen delivery
Failure to reverse severe respiratory acidosis despite intensive therapy
Ph 7.2
Complications of severe asthma
aspiration pneumonia
Pneumomediastinum
Pneumothorax
Rhabdomyolysis
Respiratory failure and arrest
Cardiac arrest
Hypoxic ischaemic brain injury
