Pathophysiology
•Chronic Bronchial Inflammation.
•Airway Hyper-responsiveness.
•Obstructive airflow limitation.
Asthma is characterised by
Wheeze, cough, shortness of breath
Symptoms of asthma
First degree relative
Family Hx atopy
2.5mg + 500 micrograms
dose of salbutamol neb and Ipratropium neb in acute exacerbation
>1 year
Occupational asthma usual onset after how long?
Type 1
What type of hypersensitivity reaction
On auscultation
Polymorphic expiratory wheeze
Obstructive
What would you see on spirometry ?
4 hours
Patient must be stable for this long before discharge and PEFR >75%
Quite
When are you are very worried about an asthma exacerbation
PEFR variation >20%
Diurnal Variation manifests as what?
Asthma exacerbation
Nocturnal cough
PEFR >50-75% of predicted
Moderate Asthma
3 reasons not to discharge asthmatic from ED
Exacerbation whilst on course of steroids.History of poor compliance with treatment.History of depression/anxiety.History of severe/refractory asthma (i.e. previous ICU admissions, on specialist drugs).Pregnancy.Poor social circumstances.
oral candidiasis
Side effect of beclometasone
Triad that occurs in asthma exacerbation
Bronchospasm, mucosal thickening, mucous production
Eosinophilic, exercise induced, occupational
Types of bronchial asthma
RAST
Test used to measure IgE
AIR therapy
First line treatment for >12years. low dose ICS/formoterol comb inhaler
4 triggers of asthma
Pets, dust, temperature, occupational exposure and smoking
pulmonary oedema, EGPA, Foreign body and post viral BHR
Other than asthma and COPD what causes wheeze?
PaCO2 = 5.5
CO2 on ABG of a Life-threatening asthma
FeNO testing
Confirms eosinophilic airway inflammation in those >17
BIPAP / Mechanical ventilation
type 2 resp failure (near-fatal exacerbation)
PEFR <33%
Severe life threatening asthma peak flow