Asthma

Question 1

What is the presentation of asthma?

Answer 1

• progressive dyspnea
• worst at night
• alleviated by salbutamol
• aggravated by perfumes
• associated with dry cough that’s worst at night
• frequent sneezing

Question 2

What are the important positive in the diagnosis of asthma?

Answer 2

• eczema history
• asthmatic mother
• new pets

Question 3

What will be found upon examination & investigation of asthmatic patient?

Answer 3

• positive bilateral expiratory wheeze
• expiratory noise
• rhonchi
• tachypnea
• tachycardia
• hypoxia
• silent chest is exacerbation -> INTUBATE

Question 4

What is the pathophysiology of asthma?

Answer 4

1- allergen
2- activated mast cells & IgE
3- high eosinophils
4- reversible airway broncho constriction

Question 5

What investigations are done for confirmation of asthma diagnosis?

Answer 5

• eosinophilia
• hypokalemia -> due to inhaled salbutamol
• pulmonary function test FEV1/FVC = 65 -> FEV1 increase 12& with bronchodilator
• bronchoprovocation test -> inhaled methacholine or mannitol -> decrease FEV1 by 8%

Question 6

What will be seen in asthma exacerbation?

Answer 6

• usually respiratory alkalosis
• respiratory acidosis IN CRITICAL

if ABG is normal in exacerbation -> INTUBATE

Question 7

How is asthma managed?

Answer 7

1- low dose ICS
2- low dose ICS + LABA
3- low dose ICS + increase LABA +- leukotriene inhibitors
4- IgE inhibitors

Question 8

How is asthma exacerbation managed?

Answer 8

• peak flow rate to asses -> if below 200L/min -> CONFIRMS DIAGNOSIS
  1- in first hour SABA -> 20 mins -> SABA -> 20 mins -> SABA
  2- SAMA -> if SABA is not enough
  3- systemic corticosteroids if SAMA & SABA are not enough

Question 9

How can we differentiate life threatening asthma exacerbation?

Answer 9

• altered mental status -> CO2 narcosis (hypercapnia)
• respiratory acidosis -> silent chest

INTUBATE +- IV magnesium sulfate