Asthma Flashcards
Pathophysiology of Asthma
- Asthma is caused by inflammation of the bronchi, making them narrower
- The muscle around the bronchi become irritated and contract, worsening the symptoms.
- The inflammation can cause the mucus glands to produce excessive sputum, further blocking air passages
- Ongoing inflammation can lead to scar tissue forming which thickens the airway walls
Signs and Symptoms
- Wheeze
- Coughing (can be worse at night or in the morning)
- SOB
- Chest tightness/pain
- Other nonspecific symptoms in children might; hx of recurrent bronchitis, bronchiolitis, pneumonia, persistent cough with colds, recurrent croup
Causes of Asthma
- Allergy related condition (or already irritated due to allergy eg hay fever)
- Smoke, dust, fumes, mould, damp
- Medicines (NSAIDS)
- Stress
- Sudden weather changes
- Excersise
- Adult onset
Pathophysiology of Recovery in Asthma
- Smooth muscle returns to normal with salbutamol inhaler
- Over time, the bronchial tree becomes less effective at recovering
Medical Risk Factors in Asthma
- Previous hospital admissions
- Anaphylaxis
- High B2 agonist requirements, especially with little or no response
- Brittle asthma
- Multiple ED attendances in 12 months
Psychological/Behavioural Risk Factors in Asthma
- Non compliance with treatment and medication
- Failure to attend appointments/self-discharge
- Psychosis, depression, other psychiatric illness or deliberate self harm
- Alcohol or drug abuse
- Smoking
- Obesity
- Severe stress, abuse, employment/income problems
Things you may see in your Primary Survey Asthma
- Clearly abnormal resp rate
- Tripoding
- Exhaustion
- Continual use of inhaler
- Clammy/sweaty
- Audible wheeze
History in Asthma
- Patients requiring hospital usually have developed symptoms gradually over a number of hours (>6 hours)
- There may be a hx of increasing wheeze/breathlessness which is often worse at night or early in the morning.
- Respiratory infection, allergy, cold weather and physical excertion can also be triggers
Considerations in Asthma
- Monitor oxygen and resps rate closely for signs of deteriorations
- History taking must be thorough
- Make sure to relisten to the chest
Life-Threatening Asthma Symptoms
- Altered conscious lvl
- Exhaustion
- Cyanosis
- Silent Chest
- Poor respiratory effort
- PEF <33% best or predicted
- Arrhythmia
- Hypotension
Sever Asthma Symptoms
- PEF 33-50% best or predicted
- SpO2 less than or equal to 92%
- Inability to complete sentences in one breath
- Tachycardia
- Increased resps
Moderate Asthma Symptoms
- Able to speak in sentences
- Increasing symptoms
- PEF >50-75% best or predicted
- Tachycardia in children only
- Increased resps in children only
Life-Threatening Asthma Management
- Consider early and low threshold of enhanced care support
- Prednisolone administration by PPs could be considered
- IV Magnesium administration (CCP)
- Adrenaline 1:1,000 IM
- Assess for bilateral tensions
- Time-critical transfer and ACHISE
Mild Asthma Symptoms
- Below best lvl of functioning due to wheeze
- PEF over 75%
- No features of moderate or worse asthma
Asthma Algorithm
- Pt own inhaler, looking for improvement/deterioration
- Salbutamol nebuliser with oxygen attachment - reassessing (5mg with 5 min intervals)
- Ipratropium Bromide (nebulised 500mcg)
- Hydrocortisone/prednisolone (PP)
- IV Magnesium - CCP
- Adrenaline 1:1000 in life threatening asthma
Preventer Inhalers; what are they, what do they do?
- They are either steroidal inhalers, milder anti-inflammatories or long-acting beta agonists
- These drugs act on the lung over a period of time to reduce the inflammatory reaction of asthma
- Regular use can eradicate asthma symptoms
Releiver Inhalers; what are they? how do they work in the body?
- If a patient uses them more than 3 times a week could suggest that there not managing their condition well
- Short-acting beta agonist relievers work rapidly in the lungs to relax the smooth muscle spasm
- Patients may sometimes have spacers that aid the administration
Montelukast; why/when is it prescribed? how does it work in the body?
Its a long term maintenance medication. May be prescribed if asthma is worsening despite using a preventer inhaler
The drug inhibits the action of leukotrienes, chemicals that contribute to inflammation and narrowing of the airways
Oral tablet
Asthma Surgery
Bronchial thermoplasty is a surgery offered to patients with sever asthma
The procedure uses heat on the muscles around the airway, preventing further narrowing of the airway to aid symptoms
List of Asthma Differentials
- Smoke inhilations
- Inhaled foreign body
- Anaphalaxis
- Cardiovascular causes
- Anxiety attack
