L2W1 CP & Inv BA

Question 1

Definition of asthma?

Answer 1

• Heterogeneous disease(char by chronic airway inflammation)

- History resp symp(WCSC) vary over time and intensity w vary expiratory airflow limitation

Question 2

Risk factors BA? ( GF AE COP)

Answer 2

1. Gender
2. Fam his
3. Allergen
4. Enviroment
5. Ciggrate
6. Obese
7. Preg

Question 3

Triggers factor of asthma? (Non/allergic)

Answer 3

Allergic
-dust, polle, fungal, pet
Non-allergic
-exercise, food, drink, drug, viral inf, smoke, job, GERD

Question 4

CP BA?

Answer 4

Symptoms

1. Chronic cough(>night)
2. Wheeze
3. Short breath & chest tight
4. Symp occur/worse after exercise, Up Resp TI, allergen expose
5. Symp occur/worsen night
6. Fam his asthma/atopic diseases

Signs
1. No/minimal sign between attack
2. During attacks:
•Harsh vesicular breath sound w prolong expiration
•Audible wheeze & rhonchi on auscultation
•Silent chest in severe case
•Course asthma is vary, period & unpredict, exacerbate vary(brief-ever)

Question 5

Types of asthma?(8) (DO EI CAN)

Answer 5

• Extrinsic asthma(child)
• Intrinsic asthma(mid)
• Exercise induced asthma
• Occupational asthma
• Drug-induced asthma(NSAID,BB,ACEi)
• Cough variant asthma
• Acute severe asthma
• Near-fatal asthma

Question 6

Def acute severe asthma?

Answer 6

Progress attack bronchospasm until patient breathless at rest

Question 7

CP acute severe asthma?

Answer 7

Symptom

• Difficult speech
• Anxiety & diaphoresis
• Respiratory distress at rest

Sign

• Use accessory ms of respiration
• Respiratory rate >30/min
• Pulse >120/mL
• Pulsus paradoxus inspiratory fall systolic bp >10mmHg
• Cyanosis(very severe)

Chest auscultation

• Inspiratory and expiratory wheeze
• Silent chest(audible later w improve att)

Question 8

Inv acute severe asthma?

Answer 8

• Peak flow meter <60L/min

- Dec PaO2 w N PaCO2, Later, PaCO2 may increase

Question 9

Inv BA(8)

Answer 9

1. Pulmonary fx test(spirometry)
2. Peak expiratory flow
3. Blood gases
4. Radiology(CXR)
5. ECG
6. Detection allergen
7. Bl picture(leukocytosis)
8. Sputum(curshman’s spiral, creola bodies, charcot lryden crystal)

Question 10

DDx BA

Answer 10

Common simulator:
-COPD:chronic bronchitis, emphysema
Other types asthma:
-Cardiac asthma ( left sided heart failure).
-Renal (uremic) asthma.
-Factitious asthma (VC dysfunction).
Other cause cough & wheezes:
-Acute bronchitis
-Bronchiectasis
-FB inhalation
-Bronchial (Carcinoid) tumor
-Drug induced cough w ACEi

Question 11

Comp BA(7)

Answer 11

• Resp fail may follow ASA
• Chronic severe asthma w steroid resistance
• Spontaneous Pneumothorax
• Fractures ribs & other comp repeated cough(old age)
• Segmental collapse(plugging w mucus)
• Allergic bronchopulmonary aspergillosis
• Psychological troubles