Working Problem 5 - Asthma

Question 1

what provides the most accurate and sensitive measurement of how well the patient is being oxygenate?

Answer 1

Arterial blood gases levels and NOT finger oximetry

Question 2

What is asthma ?

Answer 2

Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-sensitivity. Many cellular components are involved in the asthmatic pathway, including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. On insult, in susceptible people, inflammation causes increased bronchial hyper-responsiveness and recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, which are usually associated with widespread but variable airway obstruction that is reversible either spontaneously or with treatment.

Question 3

How do you assess asthma?

Answer 3

• Recurrent episodes of dyspnoea, chest tightness, wheezing, or coughing typically occur.
• The patient’s medical history may help to identify allergen exposures that worsen the patient’s asthma, for example, episodes may be exacerbated by exposure to irritants such as tobacco smoke or fumes from chemicals, such as bleach. Attacks may occur seasonally or upon exposure to cats in allergic patients. Exercise can also make the symptoms worse.
• More severe asthmatics have night-time symptoms, waking them up from sleep. In severe exacerbations, patients are continuously short of breath, and may use accessory muscles of respiration.
• The examination may be normal in patients with bronchial asthma. Examination of the nasal passages may reveal nasal polyposis or nasal congestion. Chest auscultation may reveal expiratory wheezes.
• With more severe asthma, the wheezes may be audible without the use of a stethoscope. In patients with severe exacerbations, the lung examination may be silent.

Question 4

What are the investigations performed and what do they show?

Answer 4

• FEV1/FVC ratio -

Question 5

What is the management for asthma?

Answer 5

• Mild intermittent and exercise induced
+ Patient education and environmental control
+ Short acting beta agonist (SABA) as needed – salbutamol
+ Optional ipratropium bromide inhaled
• Mild persistent
+ Low dose inhaled corticosteroids – flutiasone or budesonide
+ Leukotriene-receptor antagonist (montelukast) or sodium cromoglycate or theophylline
• Moderate percipient
+ Long acting beta agonist (LABA) – salmeterol
+ Medium dose inhaled corticosteroids – flutiasone or budesonide
• Severe persistent
+ High dose inhaled corticosteroids
+ Immunomodulator – omalizumab (binds IgE preventing mast cell activation)
• Severe persistent unresponsive to high dose inhaled corticosteroids
+ Oral corticosteroids – prednilosone
• Known allergen
+ Allergen immunotherapy

Question 6

What is status asthmaticus?

Answer 6

Status asthmaticus is an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary from a mild form to a severe form with bronchospasm, airway inflammation, and mucus plugging that can cause difficulty breathing, carbon dioxide retention, hypoxemia, and respiratory failure.