Asthma

Asthma is characterized by chronic inflammation, hyperresponsiveness to various stimuli, and

airflow obstruction; mediated by eosinophils and mast cells
RF
o Personal Hx or FHx of atopy
o Viral URIs
o Some occupational exposures (perfumes, cleaners, detergents)
o Irritants (tobacco smoke, wood smoke)
o Medications (BBs, ASA, NSAIDS)
S/Sx
o Recurrent episodes of cough, dyspnea, chest tightness, wheezing
o Most often occur at night and early morning hours a/w allergens
o May be seasonal
PE
o Wheezing, prolonged expiratory phase
o Signs of atopy (eczema, rhinitis, nasal polyps)
o Note
Normal chest exam does not exclude asthma as a Dx
Presence or intensity of wheezing is an unreliable indicator of severity of asthma
attack
Associated conditions
o Rhinosinusitis/Nasal polyps (with NSAID/ASA use)
o Vocal cord dysfunction
o GERD
o Obesity
o OSA
Increased PaCO2 signals a potential for respiratory failure; necessitates hospitalization
Labs:
o Spirometry (PFTs) show obstructive lung disease pattern
FEV1/FVC < 0.7 (moderate persistent or severe persistent)
FEV1 improves > 12% after use of 2-4 puff of a short-acting bronchodilator
(reversibility; D/Dx: COPD)
o If spirometry is normal, perform Methacholine challenge (positive if FEV1 drops 20%)
Classification of Asthma
o Mild intermittent
o Mild persistent

o Moderate persistent

o Severe persistent

Classification of Exacerbation of Asthma

o Moderate exacerbation
o Severe exacerbation
o Impending respiratory arrest

Treatment
o Identification and avoidance of triggers
o Rescue short-acting beta agonist, inhaler (albuterol)
o Low-dose corticosteroid, inhaler
o Long-acting beta agonist, inhaler (salmeterol)
o High-dose corticosteroid, oral