asthma

• What is asthma?

  Chronic inflammatory condition of the airways
• What is a specific feature of asthma?

  Reversible bronchoconstriction
• What type of condition is asthma?

  Chronic inflammatory condition
• What are the features of asthma?

  • Symptoms are episodic
  • Diurnal variability (worse at night & early morning)
  • Dyspnoea
  • Wheezing
  • Chest tightness
  • Expiratory wheeze on auscultation
  • Reduced peak expiratory flow rate (PEFR)
• What are common signs of asthma?

  Dyspnoea and wheezing
• What are the triggers of asthma?

  • Animals
  • Exercise
  • Night time & early morning
  • Cold air
  • Dust
  • Infection
  • Personal or family history of atopy
  • Smoking
  • Allergens
• What drugs worsen asthma?

  Beta-blockers, aspirin, NSAIDs
• What investigations are done for asthma?

  • Spirometry (FEV1:FVC ratio <70% indicates obstruction)
  • FeNO test
  • Peak expiratory flow variability
• What does a FEV1:FVC ratio <70% indicate?

  Obstructive picture in asthma
• What indicates reversibility in asthma during spirometry?

  More than 12% increase in FEV1
• What is the normal FeNO level?

  Less than 40 parts per billion
• What is the management guideline for asthma for patients aged ≥12?

  1. AIR (ICS + LABA)
  2. Low dose MART (ICS + LABA)
  3. Moderate dose MART
  4. Add LTRA or LAMA if needed
• What is the management guideline for asthma for patients aged 5-11?

  1. Low dose ICS + SABA
  2. Can use low dose MART
  3. Add LTRA if needed
• What are the signs of acute exacerbation of asthma?

  • Progressively worsening shortness of breath
  • Use of accessory muscles
  • Increased respiratory rate
  • Symmetrical expiratory wheeze on auscultation
  • Chest sounds tight with reduced air entry
• What is the initial ABG finding in asthma?

  Respiratory alkalosis
• What indicates respiratory acidosis in asthma?

  High levels of CO2 and low pH
• What are the signs of moderate asthma exacerbation?

  1. PEFR 50-75%
  2. Speech normal
  3. RR <25
  4. HR <110 bpm
• What are the signs of severe asthma exacerbation?

  1. PEFR 33-50%
  2. Can't complete sentences
  3. RR >25
  4. HR >110 bpm
• What are the signs of life-threatening asthma exacerbation?

  1. PEFR <33%
  2. SaO2 <92%
  3. PaO2 <8 kPa
  4. Normal CO2
  5. Silent chest
  6. Cyanosis
  7. Poor respiratory effort
  8. Altered mental status with drowsiness
  9. Exhaustion

  10. Hypotension
• How is asthma exacerbation managed?

  1. Oxygen (maintain 94-98% saturation)
  2. Salbutamol 5 mg nebulizer
  3. Hydrocortisone IV 100 mg or oral prednisolone 40-50 mg
  4. If severe, add Ipratropium bromide and Theophylline
  5. Magnesium sulfate IV if needed
  6. Escalate care if necessary
• What must be given if a patient is improving after an acute exacerbation of asthma?

  Salbutamol every 4 hours and prednisolone
• When would you need to intubate an asthmatic patient?

  Respiratory acidosis with high CO2

  pH is 7.1

  silent chest

  breath sounds are quiet

  semi-conscious

  respiratory decompensation
• What are the signs of respiratory decompensation in asthma?

  • Decrease in respiratory rate
  • Silent chest
  • Quiet breath sounds
  • Semi-conscious state