Asthma Patho
Characterized by increased responsiveness of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the airways; hypertrophy of smooth muscle, mucosal Edema and hyperemia, thickening of epithelial basement membrane, hypertrophy of mucous membranes, acute information, including of airway by thick viscus mucus
Most important allergens
*indoors Dust mites Pets Cockroaches Indoor molds Exercise Cigarette smoke
Signs and symptoms of asthma
- pulsus paradoxus > 12 mmHg
- hyperresonance
- ominous signs include fatigue, absent breath sounds, paradoxical chest or abdominal movement, inability to maintain recumbency, cyanosis
Respiratory distress at rest
Difficulty speaking in sentences
Diaphoresis
Use of accessory muscles
Respiratory rate greater than 28
Pulse greater than 110
Call
Chest tightness
Lab and Diagnostics for asthma
Slight WBC elevation with eosinophilia
PFT abnormal
Hospitalization if FEV1 < 30% after treatment or peak flow < 60
* initially respiratory alkalosis with mild hypoxemia
CXR shows hyperinflation
Stepwise approach for managing asthma in adults
Step one
SABA
Step wise approach for managing asthma and adults
Step 2
Low dose ICS
Stepwise approach to managing asthma and adults
Step 3
Low dose ICS + LABA
Stepwise approach for managing asthma in Adults
Step 4
Medium dose ICS + LABA
Stepwise approach for managing asthma and adults
Step 5
High dose ICS + LABA
Stepwise approach for managing asthma in adults
Step 6
High dose ICS + LABA + oral corticosteroid
Inpatient management of asthma
Supplemental oxygen Inhaled SABA Inhaled anticholinergics Systemic glucosteroids Magnesium sulfate single dowse 2g over 20 min if not responding to above Anaphylaxis - epi
Epinephrine dose for anaphylaxis
0.3-0.5mg SQ
SABA
Albuterol ( proventil)
Levalbuterol ( xopenex)
Low dose ICS
Budesonide ( pulmicort)
Fluticasone ( flovent HFA)
Triamcinolone (Azmacort)
LABA
Salmeterol ( Serevent)
Formoterol ( perforomist)
Combination preparations
Fluticasone + Salmeterol = Advair
Formoterol + budesonide = symbicort
Low dose ICS + LABA
Status asthmaticus
Term used to describe severe, acute asthma presenting in an unremitting, poorly responsive, life-threatening manner; clinical findings are not reliable indicators of the severity of asthma
Management of status asthmaticus
Oxygen D51/2NS Inhalation/ parent wrap sympathomimetics IV methylprednisolone 60-125 mg or hydrocortisone 300mg IV immediately Consider atrovent Monitor pulse ox Abg q10-20 minutes Intubate
