Asthma

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Asthma

  1. 1. Asthma Steven Podnos MD
  2. 2. Pathophysiology <ul><li>Asthma is an inflammatory disease characterized by bronchial wall thickness, hyper secretion of mucus and bronchospasm. </li></ul><ul><li>It often has an allergic component when it begins at a young age. Non allergic asthma can begin at any age, but a connection to post infectious states is observed </li></ul>
  3. 3. Symptoms <ul><li>SOB </li></ul><ul><li>Cough </li></ul><ul><li>Wheeze </li></ul><ul><li>Chest Tightness </li></ul>
  4. 4. Signs <ul><li>Wheezing (r/o vocal cord disease) </li></ul><ul><li>Increased Resp Muscle effort </li></ul><ul><li>Note that severe asthma may present with “quiet lungs” </li></ul><ul><li>O2 sat usually “ok” </li></ul><ul><li>Elevated pCO2 is critical sign in absence of chronic COPD </li></ul>
  5. 5. Rx <ul><li>Observation </li></ul><ul><li>Steroids </li></ul><ul><li>Bronchodilators </li></ul><ul><li>O2 </li></ul>
  6. 6. Acute RX-Status Asthmaticus <ul><li>Failure to improve with simple Rx </li></ul><ul><li>Emergency </li></ul><ul><li>IV Steroids </li></ul><ul><li>Continuous or Interrupted Bronchodilators </li></ul><ul><li>O2 </li></ul><ul><li>Vent if deteriorates </li></ul>
  7. 7. Mechanical Ventilation in Asthma <ul><li>Need increased expiratory time </li></ul><ul><li>Slow rate, short inspiratory time </li></ul><ul><li>May need to paralyze </li></ul><ul><li>Large risk of “auto PEEP” and barotrauma </li></ul><ul><li>Disconnect patient from vent for problems and bag </li></ul>
  8. 8. Specific Medical Rx –Asthma <ul><li>Steroids-enough but not too much? </li></ul><ul><li>Bronchodilators-short and long acting B2 agents (albuterol, Xopenex). Also anticholinergics-Atrovent </li></ul><ul><li>Theophylline? </li></ul><ul><li>Antibiotics-controversial, often used </li></ul><ul><li>O2-keep sat over 90% </li></ul>
  9. 9. Monitoring <ul><li>Observation </li></ul><ul><li>Mentation </li></ul><ul><li>Resp Rate </li></ul><ul><li>ABGs confirm clinical assessment only </li></ul>
  10. 10. Chronic Rx-Asthma <ul><li>Guided by doses of albuterol /day </li></ul><ul><li>Add anti-inflammatory-inhaled steroid or Singulair (discuss) </li></ul><ul><li>Role of LABA and LAMA and combinations </li></ul><ul><li>Oral steroids </li></ul><ul><li>Allergy Rx </li></ul><ul><li>Link between nasal allergies and asthma </li></ul>

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