15. Asthma Bronchiectasis - Winroth

• IgE plays a central role in allergic asthma
• IL- important in promoting eosinophilic inflammation
• Asthma clinical symptoms

  • wheezing
  • episode of dyspnea
  • chest tightness
  • coughing
• Asthma - physical exam

  • pt will use accessory muscle of inspiration
  • pulsus paradoxes
• Asthma - diagnose with?

  lung function test or PFT
• Pulmonary function test in people with asthma will show?

  • reduce FEV1
  • reduced FEV1/FVC ratio
• In asthma - we have to confirm that there is airway obstruction

  • reversible airflow obstruction test - 15 min use use B2 agonist there should be an increase in FEV1 and FVC
• Asthma - CXR?

  normal
• Asthma - HRCT?

  no used to diagnose but done to see air trapping
• Asthma other diagnostic test

  • bronchoprovocation challenge
  • exercise challenge
  • skin prick test
  • positive in allergic asthma
  • negative in intrinsic asthma
  • fractional NO
  • measure inflammation and compliance
• Acute severe asthma or status asthmaticus - pt have a history of progressive dyspnea with increasing bronchodilator use
• Before we step up in therapy in asthmas: check?

  • if pt is using it correctly or adhere to the meds
• Status asthmaticus treatment

  • bronchodilator and intravenous steroids
  • continue monitor with pulse oximetry
  • arterial blood gas analysis
• What is a bad sign in pts with asthma?

  increasing PaCO2 - require ventilatory support
• Mechanical ventilation for pt with status asthmaticus

  • use paralytic agent to control breathing patten
  • use inhaled general anesthesia to relieve bronchospasm
• status asthmaticus - who have respiratory failure can leas to intubation and mechanical ventilation
• Asthma in pregnancy

  • assure the pt about the safety of SABA and theo during pregnancy
• itraconazole can prevent aspergillosis infection for people with asthma
• Asthma prognosis is good, but there is no cure
• Bronchiectasis - bronchi is?

  • dilated
  • destructed walls
  • filled with mucus
• Bronchiectasis - result form inflammation and permanent destruction changes of bronchial walls

  • there is irreversible dilation
• Dilated bronchi are easily collapsible giving rise to

  • dyspnea
  • cough
  • hemoptysis
• Bronchiectasis: Signs and Symptoms

  • persistent chronic cough with thick sputum
  • finger clubbing
  • cracking
  • wheezing
• Bronchiectasis there is no signs of infection
• Bronchiectasis CXR

  • tram track (parallel lines)
• Bronchiectasis HRCT - choice for confirming diagnosis

  • tram track or "signet rings" - due to bronchial wall thickening
• Bronchiectasis: Management

  • control infection
• Bronchiectasis: Prognosis

  • massive hemoptysis - may be fata