The document discusses the pathophysiology, symptoms, diagnosis, and treatment of asthma, including triggers like dust and pet dander. It details the use of various medications such as bronchodilators and corticosteroids, as well as protocols for managing acute asthma exacerbations. Diagnostic measures like pulmonary function tests and assessment of symptoms are emphasized for effective asthma management.

1. Cough
Chest tightness
SOB
Difficulty
speaking
Accessory
muscle use
Hyper-resonance
Wheezing upon expiration
Eosinophil
Proteases (chronic)
Leukotrienes
Histamines
Leukotrienes
Samter’s triad
Asthma
Nasal polyps
ASA sensitivity
*Dust *smoke
*Pet dander/hair
*Cockroaches
*Cold/exercise
*Viral uri*
Environmentally
Hygiene
Hypothesis
Late onset
Asthma
Atopic triad
Asthma
Atopic
dermatitis
Allergic
rhinitis
Prostaglandins Leukotrienes
PGE
PGI
PGF
LtB
LtC
ltD
LtE
Bronchoconstriction
Mucous buildup
Inflamed mucosa
Vascular permeability
Reversible
Sputum
Curschmann
spirals
Charcot-Leyden
crystals
Pulmonary function test (PFT’S)
*FVC
*FEV
FVC/FEV
(Obstructive)
SAB A
FEV 12 after saba Asthma
FEV 12 after saba COPD
(Symptomatic)
Methacholine challenge test
PFT’S
FEV
FVC
FEV/FVC<75
PFT’S
FEV drop 20 or
more from the
original FEV
Methacholine
Bronchoconstriction
(Asymptomatic)
CBC Eosinophils
I E CxR Hyperinflation
of lungs
Type Frequency of
daytime SxS
Frequency of
night-time SxS Fev Medication
protocol
Intermittent
Mild
Moderate
Severe
<2/wk
>2/wk
7/wk
Throughout
the day
<3/month
SAB A
Albuterol
Levalbuterol
B -ar Bronchodilation
Adr
tachyarrhythmia
Tremors
Dizziness
3-4x/month
>80 SABA (prn)
>80 SABA (prn)
Dose ICS
Corticosteroids
Fluticasone
Budesonide
Mometasone
Inhaled (dpi) Cytokines
Inflammation
ADR
Candidiasis
1+/wk 60-80
SABA (prn)
Medium Dose ICS
Dose ICS L ABA
LAB A
Formoterol
Salmeterol
Black box warning
Never for acute exacerbations
Never give without an ics
Throughout
the night
<60
SABA (prn)
Medium Dose ICS
L ABA
SABA (prn)
Dose ICS
L ABA
SABA (prn)
Medium Dose ICS
L ABA
Po
corticosteroids
Corticosteroids
Methylprednisolone
Prednisone
Prednisolone
PO
or
IV
Short term
stabilizers
Cromolyn sodium
LTRA
Montelukast
Omalizumab
Anti - I E
Mast cell
*Acute asthmatic exacerbation*
*pefr >70 Of age, gender, height
Pt#1 SABA Improve Discharge
Pt#2 SABA Does not PEFR
Pt#3 rr
hr
Pt#4 O sat < 92
pefr < 25
No wheezing
Pt#5 O sat < 92
Pefr < 25
No wheezing
Readily
Improve
(50-70 )
ABG
pH
Pco
Po
HCO
pefr
(25-50 )
abg Normal
Pco
abg Pco
(Complete airway
Obstruction)
Respiratory
acidosis
Treatment
Non-rebreather supplemental o > 92
SAB A + ipratropium bromide
Nebulizer
Inhaler
IV or Po corticosteroids
IV magnesium sulfate
Positive pressure ventilation
Intubation (endotracheal)
Pathophysiology, symptoms,
diagnosis and treatment of asthma
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