Bronchial Asthma

Question 1

Definition of Bronchial asthma

Asthma can be minor or it can interfere with daily activities. In some cases, it may lead to a life-threatening attack. True or false?

………… asthma manifest as?

……..,,,,,,,, it is characterised by ?

Asthma is variable and may be associated with seasons like the rainy season or harmattan. True or false?

Bronchial asthma occurs at all ages but peaks in childhood. It is classified as an allergic disease, and may be associated with a personal or family history of allergic rhinitis (hay fever), eczema or allergic conjunctivitis.

Answer 1

Bronchial Asthma is A condition in which a person’s airways become inflamed, narrow and swell and produce extra mucus, which makes it difficult to breathe.

True—Asthma can be minor or it can interfere with daily activities. In some cases, it may lead to a life-threatening attack.

Asthma is a chronic inflammatory disease of the bronchial airways, which manifests as recurrent episodes of wheeze, cough, chest tightness and shortness of breath, which is usually reversible with treatment.

It is characterised by increased sensitivity to many environmental agents.

True— Asthma is variable and may be associated with seasons like the rainy season or harmattan.

True— Bronchial asthma occurs at all ages but peaks in childhood. It is classified as an allergic disease, and may be associated with a personal or family history of allergic rhinitis (hay fever), eczema or allergic conjunctivitis.

Question 2

Complications

Answer 2

Complications of asthma include pneumomediastinum, pneumothorax, subcutaneous emphysema and pneumonia

Question 3

Causes

Answer 3

Causes
y Allergens e.g. house dust mite, cockroach droppings, grass, pollen and animal hair
y Environmental factors e.g. air pollution, climatic changes, strong scents and smoke (including cigarette smoke and car fumes)
y Viral infections
y Exercise
y Emotions and hyperventilation
y Drugs e.g. aspirin, NSAIDS and beta-blockers such as propranolol
y Occupational exposure to industrial chemicals, dust and drug
manufacturing

Question 4

Signs and symptoms

Answer 4

Symptoms
y Episodic breathlessness y Tightness of the chest y Cough - often nocturnal y Wheeze
y Nocturnal symptoms. Any of the above symptoms waking up the patient at night
Signs
y Tachypnoea (fast breathing)
y Use of accessory muscles of respiration; neck and/or abdominal
muscles
y Rhonchi/wheeze

y Signs of severe attack
y Inability to complete full sentences in one breath
y Rapid pulse > 110/minute in adults and adolescents or >130/
minute in children 2-5 years
y Rapid respiration > 30/minute in adults and adolescents or or >
50/minute in children 2-5 years
y Peak Expiratory Flow Rate (PEFR) is reduced < 50% of expected
(for age, sex and height)
y Signs of a life-threatening attack are:
y Cyanosis
y Pulsus paradoxus
y Silent chest on auscultation
y Drowsiness or confusion
y Exhaustion
y Peak Expiratory Flow Rate (PEFR) less than 33 % of expected value
y SpO2 less than 92% on room air

Question 5

Investigations

Answer 5

Investigations
** No investigation required in most cases
— FBC, mildly high eosinophil count
— Chest-Xray(only for the exclusion of other diagnoses or complications)
— Spirometry - reduction in FEV1 and FEV1/FVC ratio with reversibility
demonstrated after bronchodilator use (a normal spirometry
between attacks does not exclude asthma).
— Tests for atopy - skin prick test or specific IgE for common allergens
— Stool examination, exclude helminthiasis

Question 6

Treatment

Pharmacological treatment— STG page 176

Answer 6

Treatment
Treatment objectives
y To relieve bronchospasm
y To prevent complications and recurrence
y To treat underlying inflammation or infection
Non-pharmacological treatment
y Avoid known triggers/allergens, such as dust (dust mite) where possible
y Avoid smoking
y Education on asthma self management, device use and technique

Answer 7

Review treatment every 3-6 months with a view to stepping down treatment if client is symptom-free or has minimal symptoms (<1-2 times a month).
All patients with chronic Asthma should receive continuous education and counselling by the medical team.
Referral Criteria
In acute exacerbation, refer patients if not improving or rapidly deteriorating after initial management to a specialist.
All discharged clients should be followed up within one week and referred to a specialist clinic for continued care.
For chronic asthma refer patients with persistent symptoms to a specialist clinic in a regional or tertiary hospital, and patients who have recurrent acute exacerbations within a few days/ weeks of each other for specialist care and review of their treatment.
Also refer when a patient requires more than one course of oral prednisolone in 3 months.