Asthma Flashcards
Typical patient
usually children with co-exisitng atopy, overweight and family history.
Symptoms
Cough, chest tightness, shortness of breath, wheeze.
Triggers
Cold
Allergens
Smoking
Pollution
Night
Exercise
Beta Blockers
Stress
URTI
Mild
Peak flow > 75%
No severe symptoms
Moderate
Peak flow: 50-75%
No severe symptoms
Severe
Any one of the following:
Peak flow > 33-50%
Heart rate > 110 bpm
Resp Rate > 25
Unable to complete full sentences in 1 breath.
Life Threatening
Any one of the following:
Peak flow < 33%
Poor Respiratory effort
Cyanosis
Silent chest
Confusion
Hypotension (<90/60 mmhg)
Arrhythmia
Normal PCO2
Fatal
Any symptoms of life threatening plus:
High PCO2
Treatment (non-acute)
Avoid triggers
BTS Guidelines
Assess inhaler technique
Follow self management plan
Treatment - Acute
1) A-E Assessment
2) Maintain sats 94-98%
3) ABG if <92%
4) Nebulised SABA (15 min)
5) 40mg PO Prednisolone (IV Hydrocortisone if not tolerated)
Treatment - Severe
Acute management plus:
1) Nebulised Ipatropium Bromide (500 micrograms)
2) Back to back SABA
Treatment - Life Threatening
Acute, Severe management plus:
1) IV Aminophylline
2) Assessment by ITU
3) Urgent portable CXR
4) Consider IV Salbutamol
Pathophysiology
Chronic inflammation of airways, hypersensitivity to stimuli, Mucus hyper-secretion and Mucus plugging (in severe cases)
PFT Results
Volume/ time shows shallow curve, Reduced gradient but eventually reaching the same FVC.
Volume/ Flow shows reduced peak flow, shallow coving of the arch but the same volume.
1) FEV1 < 80% Predicted
2) FEV1:FVC < 70%
3) FEV1:FVC Post Bronchodilator > 12%
Examination Findings
Eczema
Runny nose, Nasal Polyps
Hyperessonance on percussion
Expiratory wheeze on Auscultation
Differentials
Bronchitis
LRTI
PE
HF
Foreign Body
EGPA
Investigations
> 5 years old only:
Spirometry
FeNO (>40 ppb in adults)
Bloods (Eosinophillia)
IgE Levels
Routine bloods (To rule out infection)
CXR (To rule out infection)
