ASTHMA

• Asthma


  • Bronchial smooth muscle contraction (bronchospasm)
  • Mucosal edema
  • Hypersecretion of mucus
• Asthma


  A reversible obstructive airway disease characterized by airway hyper-responsiveness to certain triggering factors resulting to:
• ROAD - Reversible Obstructive Airway Disease
• Extrinsic/Bronchial or allergic type asthma


  • More common in pediatric patients
  • Often with family history
• Clinical Manifestations of Asthma

  • Bronchospasm
  • Dyspnea, tachypneic
  • Wheezing
  • Productive cough with mucoid or purulent sputum
• Clinical Manifestations of Asthma


  • Accessory muscle use; orthopnea
  • Apprehensive, flushed, diaphoretic, cyanotic, tachycardic
  • Air trapping; hyperinflation of lungs with flattened diaphragm; increased AP diameter; hyperresonant chest
• CXR of a Status asthmaticus 6-year old patient

  • Hyperaeration with flattening of diaphragm
  • Anterior bowing of sternum (increased A-P diameter)
  • Patient intubated this time. Subcutaneous emphysema - upper abdomen. Extreme hyperlusceny with secondary microcardia
  • Right lower lobe is partially collapsed secondary to mucus plugging
• Treatment for Pediatric Asthma - Quick-relief (rescue) medications

  • Use of SABA (salbutamol, terbutaline) - inhaler
• Treatment for Pediatric Asthma - Long-term control medications

  • ICS – fluticasone, budesonide, beclomethasone
  • Oral Leukotriene modifiers: montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo)
  • Combination therapy: LABA with ICS - inhaler
  • Oral theophylline
  • Immunomodulatory agents: Anti-IgE agents - mepolizumab (Nucala), dupilumab (Dupixent), benralizumab (Fasenra) for 12 years old and up, omalizumab (Xolair) for 6 years old and up
• Treatment for Pediatric Asthma - Severe asthma symptoms

  • Nebulized bronchodilators (beta agonists, anticholinergics)
  • SubQ epinephrine or IM terbutaline
  • IV methylxanthines (aminophylline drip), IV corticosteroids
  • Oxygen therapy
  • Mechanical ventilation (with severe respiratory acidosis) - To reduce work of breathing and prevent auto-PEEP, Permissive hypercapnea
  • Antibiotic therapy if bacterial infection is present