Download - Asthma - Zain Cawasji
-
7/31/2019 Asthma - Zain Cawasji
1/14
Click to edit Master subtitle style
5/23/12
AsthmaZain Cawasji
-
7/31/2019 Asthma - Zain Cawasji
2/14
5/23/12
A 26 year old lady with a history of asthma presents to the ER
with a 3 day history of progressive wheezing and shortness of
breath after an upper respiratory tract infection. She is takingSalbutamol inhalers and over the counter medication for her cold.
Her respiratory rate is 28/min, and her pulse is 110/min; she is
afebrile. Her right nasal turbinate is edematous and erythematous.
On examination there is bilateral wheezing but no crackles.
Supplemental Oxygen is given. How would you manage this patient?
-
7/31/2019 Asthma - Zain Cawasji
3/14
5/23/12
Objectives
Definition.
Pathophysiology.
Clinical Features.
Objective measures of severity
assessment. Management.
-
7/31/2019 Asthma - Zain Cawasji
4/14
5/23/12
Asthma
Asthma is a disease characterised by inflammatory
hyperactivity of the respiratory tree to various stimuli.,
resulting in reversible airway obstruction. A combination
of mucosal inflammation, bronchial muscle constriction,and an excessive secretion of viscous mucus causing
mucus plugs produce bronchial obstruction. The
bronchial hyper reactivity occurs in an episodic pattern
with interspersed normal airway tone. Asthma can occurat any age but is most commonly seen in young people,
half of whom outgrow their asthma by adulthood.
-
7/31/2019 Asthma - Zain Cawasji
5/14
5/23/12
Etiology
Genetic.
Environmental factors.
Occupational exposure.
Cold air and exercise.
Diet.
Emotions.
Drugs.
-
7/31/2019 Asthma - Zain Cawasji
6/14
5/23/12
Allergic
Immediate Asthma. Airflow limitation begins inminutes, reaches its maximum in 15-20 min and subsides within an
hour.
Dual and late phase reactions. Following animmediate reaction, many patients develop a prolonged and
sustained attack to airflow limitation that responds poorly tobronchodilators. Upto several weeks after exposure, the airways
are hyperresponsive.
-
7/31/2019 Asthma - Zain Cawasji
7/145/23/12
Pathophysiology
-
7/31/2019 Asthma - Zain Cawasji
8/14
5/23/12
Symptoms
Intermittent dyspnea
Wheeze
Cough
Sputum
-
7/31/2019 Asthma - Zain Cawasji
9/14
5/23/12
History
Precipitating Factors: Cold air, exercise, emotions, allergens(dust mite, pollen, animal fur), infection, drugs (aspirin, NSAIDs, beta
blockers).
Diurnal Variation: In symptoms or peak flow. Exercise: Amount tolerated.
Disturbed sleep: Nights per week?
Acid Reflux.
Other Atopic diseases: Eczema, hay fever, allergy, familyhistory.
The Home: Pets, carpets, feather pillows, dust.
-
7/31/2019 Asthma - Zain Cawasji
10/14
5/23/12
Signs
Tachypnea.
Audible wheeze.
Hyperinflated chest.
Diminished air entry.
Hyperresonant percussion note.
Wheezing on auscultation.
Severe attack: inability to complete sentences, pulse >110/min,
RR >25/min, PEF 33-55% of predicted.
-
7/31/2019 Asthma - Zain Cawasji
11/14
5/23/12
Investigations
Peak expiratory flow rate.
Exercise tests.
Histamine or methacholine bronchial
provocation test.
Corticosteroid trial. Blood and sputum tests.
Cheast xray.
-
7/31/2019 Asthma - Zain Cawasji
12/14
5/23/12
Management
Aims to: Abolish symptoms.
Restore best possible lung functions. Reduce the risk of severe attacks.
Enable normal child growth.
Reduce absence from work or school.
By: Patient and family education.
-
7/31/2019 Asthma - Zain Cawasji
13/14
5/23/12
-
7/31/2019 Asthma - Zain Cawasji
14/14
5/23/12