Bronchial asthma Flashcards
what is bronchial asthma ?
it is a chronic inflammation true to the hype responsiveness that leads to recurrent episodes of wheezing , breathlessness and chest tightness and coughing particularly at night and early morning
the airflow obstruction is reversible and can vary over time and in their intensity
what is the etiology of asthma ?
genetic predisposition
environmental
allergens such as pollen , fungi , mold
domestic mites and furred animals
tobacco
what is the pathophysiology in asthma ?
bronchoconstriction by the smooth muscle contracting
edema
mucus secretion hypersecretion
and coughing
cell infiltration of eosinophils , masticates , monocytes , neutrophils
and epithelial change
subepithella fibrosis
and airway thickening
= airway remodelling
classification for asthma according to etiology ?
atop asthma non topic exercise induced occupational cough variant asthma
what are the symptoms ?
persistent NON PRODUCTIVE cough episodic breathlessness prolonged expiration with wheezing cough chest tightness seasonal variability allergic rhinitis
what are the physical signs for asthma ?
percussion - hype resonant - due to hyperinflation
decreased breath sounds
tachypnea
in severe cases pluses pradoxicus accessory muscle use paradoxical thorax-abdominal movement ABSENT WHEEZING pulse over 120 saturation of oxygen less than 90 percent pco2 - more than 42mmhg
what is the diagnosis for asthma ?
spirometry - obstruction
such that FEV1 is less than 80% of that predicted,
and FEV1/FVC is less than 0.7
but in asthma normalises after attack
reversibility from bronchodilator
an increase in FEV1 of more than 12 percent
methacholin challenge test - hyper responsiveness of the ariwary
and FEV1 fall by 20 percent
peak expiratory flow - to measure the disease progression
skin allergen testing
blood hypercapni hypoxemia allergen specific iGe and serum igE and eosinophilia
ray hyperinflation
in severe - flattened diaphragm
wide intercostal space
barrel chest
how to know the severity of the asthma ?
mild intermittent symptoms such as wheezing dyspnea and coughing less than or equal to 2 days a week night time awakening - none FEV1> 80 percent
mild persistant
more than 2 days a week
night time awakening 3-4 times a month
FEV1 >80 percent
moderate
symptoms daily
night time - 1/2 times a week
FEV1 60-80
severe
symptoms throughout the days
night time - mostly dairyer
FEV1
management of asthma ?
preferred reliever for all low dose ICS - formeterol (LABA) or inhaled SABA
===========
step wise approach the controllers
mild intermittent
SABA
mild persistant
low dose ICS
or
cromolyn / LTRA /theophylline
moderate persistant
low dose ICS+ LABA /LTRA / THEOPHYLINE
severe persistant
medium dose ICS + LABA/LTRA/THEOPHYLINE
high dose ICS + LABA /LTRA/THEOPHYLINE
consider omalizimuab for allergies (blocking igE)
high dose ics + oral corticosteroid + LABA
MANagment of status asmthaticus
SABA
SAMA
oral corticosteroid
intravenous magnesium sulfate
oxygen and ventilation
indication for intubation - use of accessory muscles
decreased oxygen saturation
