Asthma Management

Asthma...the emergency missed!!

By: Dr. Ashish Sharma 

               Have you ever thought if a child 4y/o suddenly presents with wheeze(musical                                             high pitch sound)while talking.This may be the only presenting symtom.

                In a child it can be most common underlying                                           diagnosis of RECURRENT PNEUMONIA!!!

                                        

                                                                                 

                     Cough in an adult while exercising is a sign of nocturnal(night) asthma

                      i.e. in early hours of morning.It may be associated with complaint                                        of  chest tightness.

Typical symptom: Shortness of Breath, Cough, Chest pain 

        Timing of Onset of Symptoms: If Exercise continued  for >10 minutes                                                                                                  

 Now , on how can we differentiate between the symptoms of asthma for deciding severity of the case is as follows:

                

                                                    

       1) Mild: Breathlessness on physical activity(walking,talking,).Patient may feel                                     agitated.HR<100bpm.Fall in systolic blood pressure on inhalation.                                                                                                                                                                                 2)Moderate: Breathlessness,supraclavicularand intercostal retraction.HR>100bpm,Infants show feeding difficulty with soft and shorter cry. Patient prefers a sitting position.                                                                                                                                                      

                                                             

                                         

                                                        

            3)Severe: Breathlessness during rest,Can't sit,talks in words,agitation.Suprasternal retraction,HR>120bpm,increased respiratory rate, loud musical breathing, patients often accquired tripod position.                                                                                                                                                            

                                                                 

                                               RESPIRATORY ARREST?????

                        In children: Drowsy, Confused

                         

                       In Adoloscent:                                                                                          No Wheezing,RespiratoryFailure,Bradycardia

                      

     Status Asthmaticus:-

                     -No Wheezing

                    -Respiratory Muscle Fatigue

                    -Profuse Sweating

                    -Struggle for Air

                    -Confused with Agitation

                    -Phrase"i can't breath"

                    -Wanting to lie 

 All these are life threatening signs with almost no breath sounds heard

            Night Time Symptoms: Chest tightness with Breathlessness is maximum at 4:00am - 6:00am, this is the time of highest mortality.

 

         Other Manifestations: Skin Allergy known as Atopic Dermatitis, Nasal Polyp, Allergic Rhinitis, Transverse crease on nose.

                                 PATIENT  WORKUP!!!!!!!

        

-BLOOD TEST: EOSINOPHILLS>4%(300-400/uL),>8% are observed in patient with asthma associated with atopic dermatitis

-Serum IgE: >100IU

-ABG: Respiratory Alkalosis

-Pulse Oximetre: In all patient of asthma,in children it is used to describe the grading of  asthma; 

                  O2 Saturation 97%:- mild asthma

                 O2 Saturation 92%-97%:- moderate asthma

                  O2 Saturation <92%:- severe asthma

-Chest Radiograph: 

-Bronchoprovocation:

Methacholine/Histamine test: Done when spirometry is normal mostly in patient with nocturnal/exercise induced asthma.

-Histology Finding:

                      

                           

     Management of Patient:-

 -long-term goals of asthma management are risk reduction and symptom control.

- management cycle:-   

                                   

   -modifying risk factors:-

                 1) self-monitoring of symptoms and/or peak expiratory flow, a written                                 asthma action plan, and regular medical review.

                 2) avoiding exposure to tobacco

                 3) confirm food allergy

                 4) smoking cessation

                 5) Engage patient in regular physical aactivity

                 6) Ask patient of work h/o

                 7) Avoid Aspirin to prevent Aspirin Induced Asthma

-Treatment Algorithm:

          

The only purpose of the blog is to just create awareness, to serve people better.

                                                THANK YOU