Asthma

Question 1

What is asthma?

Answer 1

Chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night and in the early morning.

These episodes are usually associated with widespread but variable airflow obstruction within the lung that is often
Which is more importantly REVERSIBLE either spontaneously or with treatment.

and finally Asthma can begin at any age.

Question 2

Why ASA sensitivity causes asthma?

Answer 2

ASA inhibits the production of prostaglandin which causes more production of leukotrienes (esp L+C4, L+D4 and L+E4 which they are responsible of bronchospasm and increase production of mucus in the airway).

Question 3

What medication can cause asthma?

Answer 3

ASA and beta blockers which block beta 2 that causes bronchodialtion and then bronchconstrication happen.

Question 4

What is the function of histamine?

Answer 4

Histamine usually causes muscle relaxation but in the respiratory it actually causes constriction in smooth muscle which result in bronchconstriction.

And causes a lot of production of mucus into the lumen which responsible of airway production.

Question 5

Describe the pathophysiology of asthma?

Answer 5

Airway hyper-reactivity (AHR) – which is
the tendency for airways to narrow
excessively in response to triggers that have little or no effect in normal individuals

Asthma can be caused due to two types:
1- atopy: which is genetical ( increased prucdution of IgE that causes increase reales of histamine)
A. Allergy.
B. Sinusitis and nasal polyps.
C. Eczema.

2-triggers:
1- Allergen exposure (house dust mites, pets )
2. Medications : Aspirin , Exercise, beta blockers.
3. Clod weather
4. Infections : viruses

In other words, Pathophysiology • airway obstruction → V/Q mismatch → hypoxemia → ↑ventilation(v) → ↓PaCO2 → ↑pH and muscle
fatigue → ↓ventilation, ↑PaCO2/↓pH.

Question 6

What are Bronchial Asthma Clinical features?

Answer 6

Characterized by intermittent symptoms that include :
o SOB
o Wheezing
o Chest tightness
o DRY Cough in early morning.
*Diurnal pattern: symptoms and lung function being worse in the early
morning.

Question 7

What are the clinical examination of asthma?

Answer 7

1Vitals
o Pulse : Increased heart rate in acute severe episode
o Pulsus paradoxus
o Respiratory Rate

2. Skin:
   o Profuse sweating in imminent respiratory failure
   o Severe hypoxia resulting in central cyanosis and hypoventilation in imminent respiratory failure.

3.Eyes : suggestive of associated allergic rhinitis.

4. Nose : allergic rhinitis.

Question 8

What does it mean to have high paCO2?

Answer 8

As a general rule, a low pH with a high PaCO2 suggests a respiratory acidosis, while a low pH with a low PaCO2 suggests a metabolic acidosis.

Question 9

What kind of wheezing that suggest the severity of asthma?

Answer 9

Mild Episode : Prolong end-expiratory wheeze.

Moderate episode: Loud prolonged expiratory wheeze.

Severe episode: expiratory and inspiratory wheezing.

Very severe episode or life threatening episode: silent chest.

Question 10

What are the other causes of wheezing?

Answer 10

Cardiac asthma : Heart failure sign and symptoms + wheezing treated with diuretics.
Churg–Strauss syndrome :Autoimmune vasculitis , refractory poor
controlled bronchial asthma associated with eosinophilia
Stridor = Upper airway obstruction
Lung cancer : presenting of B symptoms associated with localized
inspiratory wheezing . Medications :
o Beta blockers
o Adenosine
o Aspirin
o NSIDS

Question 11

What is the investigation that is required for asthma diagnosis?)

Answer 11

Pulmonary Function Tests :
It is required for diagnosis.
It shows an obstructive pattern:
1- Decrease in expiratory flow rates
2-Decreased FEV1
3- Decreased FEV1/FVC ratio (<0.70)

*Reversible airway obstruction after bronchodilators by increase in
FEV1 or FVC at least 12%

Question 12

What is FVC, FEV1, TLC, and DLCO ?

Answer 12

1-Forced vital capacity (FVC): Total volume of air that can be exhaled forcefully after maximum inhalation.

2-Forced expiratory volume in 1 second (FEV1 ):
Volume of air forcefully expired from full inflation (TLC) in the first second.

3-Lung capacity or total lung capacity (TLC) : It is the volume of air in the lungs upon the maximum effort of inspiration.

4- Diffusion Capacity: Measure of gas exchange at alveolar-capillary membrane.

Question 13

What kind of investigation for follow up in asthma patient?

Answer 13

Peak flow (peak expiratory flow rate) :
1-Maximum speed of expiration.

2-Normal range between around 400 and 700 litres per minute

Question 14

What invisatgation needed to be done If PFT( SPIROMETRY) result is unclear or doesn’t diagnose asthma even though there are symptoms of asthma?

Answer 14

Bronchoprovocation test :
Also known as methacholine challenge test
Use : when asthma is suspected but PFTs are non diagnostic.
 Measures lung function before and after inhalation of methacholine
Methacholine :
o Muscarinic agonist
o Hyper responsive airways develop obstruction at lower doses.

Question 15

What is the purpose of chest X ray in asthma patients and what will find in it?

Answer 15

First, chest x ray is needed to rule out other causes but it’s not diagnostic.

1-Normal in mild cases

 Severe asthma reveals hyperinflation
o Flattened hemidiaphragmatic contours
o More than 6 anterior or 10 posterior ribs
o Horizontalisation of ribs
o Hyperlucent lungs
Need to exclude other conditions
o Pneumonia
o Pneumothorax
o Pneumomediastinum
o Foreign body

Question 16

Is blood gas helpful in investigation of asthma?

Answer 16

Yes, because we can see the levels of PaCO2 level.

Arterial blood gas ( better ) or veins blood gas
Hypocarbia is common. Hypoxemia may be present means Alarming sign Hypercapnia is very bad sign( respiratory acidosis)

Question 17

patient came to the ER with asthma symptoms, how to approach him?

Answer 17

Management:
1-ABC.
2-Medications :
A)Bronchodilators(salbutamol :Short acting SABA , Salmeterol :Long acting LABA).

B)Anti inflammatory = Steroid : ( inhaler ICS , systematic )

C) Antimuscarinic agents = Anticholinergic (ipratropium)

D) Leukotriene receptor antagonists
E) Monoclonal antibody = Biological therapy

3-Antibiotics( only with bacterial pneumonia)

4-IV magnesium

Question 18

What do we give asthmatic patient drugs back to back every 10 or 30 mintes?

Answer 18

To avoid intubation

Question 19

What kind of steroid we give for an Acute symptomatic asthmatic patient?

Answer 19

Systemic steroid oral or iv.

*We don’t give inhaler steroid in er patient
.

Question 20

What type of electrolyte that is only given in asthmatic patient and why?

Answer 20

IV MAGNESIUM
it activates the ATP in muscle.
And to prevent respiratory failure or arrest.

Question 21

If a pteint comes with high IgE what do we give him ( drug)?

Answer 21

Monoclonal antibody: (Omalizumab) 30 ml
A monoclonal antibody directed against IgE
 Blocks the binding of IL-5 to its receptor on eosinophils

Question 22

If asthmatic patient comes with asthma every 3 months we give him bronchodilator but if it’s mild or more we start with steroid

Question 23

What are Bronchial Asthma Complications?

Answer 23

 Status asthmaticus: does not respond to standard medications
Acute respiratory failure (due to respiratory muscle fatigue) Pneumothorax
 Atelectasis Pneumomediastinum ( early sign of pneumothorax)

Question 24

Stiroed not given more than 7 days

Question 25

Never do intubation in asthma patents everr