Resp - Asthma

Question 1

What is asthma?

Answer 1

• Chronic inflammatory disorder of the airways.- Associated with acute exacerbations in response to a known or unknown trigger- May be a history- Displays diurnal variation- Reversibility of airway obstruction- FEV1/FVC <65%- FEV1 <70% predicted- FEV1 >12% increase in response to bronchodilators

Question 2

What is the pathophysiology of asthma?

Answer 2

• Chronic inflammatory airways disease with:- smooth muscle hypertrophy- goblet cell hyperplasia. These changes lead to:- airway reactivity (bronchospasm) and - mucosal and submucosal oedema (mucus plugging)

Question 3

How can you assess the severity of acute asthma?

Answer 3

1. Vital signs:- HR- RR- saturations- BP2. Clinical findings:- Wheeze or silent chest- cyanosis- use of accessory muscles3. Bedside tests:- PEFR- ABG- ECG

Question 4

What are the features of acute severe asthma?

Answer 4

• PEFR 33-50%- unable to complete sentences- RR>25- HR >110

Question 5

What are the features of life-threatening asthma?

Answer 5

Clinical features:- Silent chest- poor respiratory effort- cyanosis- hypotension- arrhythmias- impaired consciousness- exhaustionVital signs:- Sats <92%Bedside tests:- normal pCO2- PO2 <8- PEFR <33%

Question 6

What are the features of near-fatal asthma?

Answer 6

Raised pCO2| Requiring mechanical ventilation