Asthma

Monday, 11 May 2015

10:52 pm

Remember that asthma is episodic

There is usually a triggering factor:

Chemicals
Dust
Exercise
Cold weather makes it worse
Emotions/ anxiety
Irritants-- cigarette smoke/ air pollution
Medications: ASPIRIN OR BETA BLOCKER
ALLERGIES
VIRAL INFECTIONS
Factors at home or at work- anything new eg. Moving house, using
chemicals, cleaning up etc

Clinical Presentation:
Breathlessness (episodic)
Wheezing
Cough (phlegm)
Chest tightness
Triggers

Worse at night/cold

Smoking Hx
Hx of atopy
Remember to ask: Impact on work and lifestyle!

Diagnosis/Investigations:
Spirometry:
Obstructive Picture:
FEV1/ FVC that improves by 12% with bronchodilator +200mL
FVC: /N
May do methacholine challenge
Peak expiratory flow

Lungs Volumes
DLCO

Chronic Management: (adults)

Drugs
Relievers
SABA

Long
acting

Inhaled
corticosteroids

(- agonist)

-agonist

(ICS)

Leukotrienereceptor
antagonist
(LRTA)

Cromones

Salbutamol

Salmeterol

Fluticasone

Montelukast

Sodiu
m cromoglicate

romil

Budesonide

Flunisolide

Zafirlukast

Beclometasone

Zileuton (oral)

Mometasone
Ciclesonide

Nedoc

Long-term control
Prevent symptoms
2nd line therapy

Theop
hylline

Management of Acute asthma:

1
2
3
4

-agonist - 4-12 minutes-- give via nebulisers if patient cannot breathe

through spacer
If patient is still not improved administer 4-12 puffs. Every 20 minutes (if
required) for the first hour
If still symptomatic add ipratropium bromide (anticholinergic) 8 puffs x 20
minutes for 1 hour
Start Oral corticosteroids (prednisolone)- no weaning required

O2!!!
Can also give Mg single infusion adjunct

Is asthma well-controlled?

Daytime symptoms <4 days/ week

Night-time symptoms < 1 night/week
Physical activity normal
Exacerbations mild, infrequent

No asthma- related absence

B2- agonist use <4 times/week
FEV1 or PEF >90% PB
PEF diurnal variation <10-15%

Ensure patient understands disease implications + is compliant & has correct

inhaler technique

Rule out DDxs

Adjust ICS dose accordingly

Start low dose

Gradually increase dose with moderate severe
Then add on LABA

Add on LTRA

DDxs in adults:
Deconditioning
Anxiety
COPD
CHF
Inhaled foreign body
Anaphylaxis

Large airway stenosis

Pleural effusion
Pulmonary fibrosis
Rhitnitis
CVD
Pulm HTN

DDxs in children:
Cystic Fibrosis
Bronchiectasis
Congenital bronchiole/bronchial dysfunction