8. • Wheeze
• Fever
• Dry / Productive
• Dyspnea / Cyanosis
• Aggravating factors (smoke, dust
,fumes )
• Relieving factors
• Weight loss
• Chocking
• Hemoptysis
• Night sweating
• Diurnal variation
• Past medical history (recurrent
attack)
• History of chocking in foreign body
• Personal history of atopy
• H/O ICU admission
• Family history of atopy
• H/O Drugs
• H/O contact with TB patient
• Vaccination
9. Ahmed have cough for more than 3 weeks
Associated with :
Wheeze
Dyspnea.
The cough was Dry , mainly Nocturnal ,no hemoptysis.
Aggravated by : smoke and dust
No H/O of choking , fully vaccinated
He is not on any drugs , no consanguinity marriage
There is a family history of atopy , his father is asthmatic and heavy smoker.
Educated parents and had a good income
10. History
For Against
Asthma
Protracted
bacterial
bronchitis
pneumonia
Foreign
body
Tuberculosi
s
Bronchiectasi
s
Cardiac
causes
Habit cough
Drugs
NO FEVER , WHEEZING , Dyspnea,
NOCTURNAL DRY COUGH , FH/
Asthma , Aggravated by Smoke and
dust
not on any drugs
Chronic dry cough
School age , Chronic cough,
Dyspnea, wheezing
Dyspnea, Chronic cough , wheezing
Wheezing , Dyspnea, Chronic cough
no fever
NO FEVER , WHEEZING , Dyspnea,
NOCTURNAL DRY COUGH
NO FEVER , Dry Cough
Chronic cough , wheezing
Examination
For Against
Chronic cough, Dyspnea,
wheezing
No previous same illness ,
Dry cough , nocturnal cough , no
fever
No fever , there's no special
aggravating or relieving factors
no h/o of FB ingestion
No fever , no weight loss ,
no contact with TB Patient ,
Vaccinated
No fever ,no wt. loss ,no h/o
recurrent pneumonia ,dry nocturnal
cough change with posture
no h/o of cardiac
disease
Wheezing , not disappearing
during sleep , relieved by
medications
11. Q3:
Which examinations are necessary to confirm
the most likely Diagnosis and to discriminate
between others?
12. • Ahmed is well , good body built
• There is signs of allergy :
Mouth breathing
Allergy shiners
Dennie lines
• Temp. 37 No R.D
• BP normal
• Pulse 140/min RR 20/min
• No LAP No pallor
• No cyanosis No clubbing
• No odema
• BCG scar present
• No skin rash
• CVS Examination : No +ve findings
• Joint was free
• Abdominal examination : No +ve
findings
• Chest examination :
Few crepitation
Chest deformity :( pectus excavatum )
• ⬇ chest expansion
• Hyper resonant on percussion
• Equal air entry with diffuse expiratory
rhonchi.
• crackle crepitation
13.
14. History
For Against
Asthma
Protracted
bacterial
bronchitis
pneumonia
Foreign body
Tuberculosis
Bronchiectasis
Cardiac
causes
Habit cough
Drugs
NO FEVER , WHEEZING ,
Dyspnea, NOCTURNAL DRY
COUGH , FH/ Asthma ,
Aggravated by Smoke and dust
not on any drugs
Chronic dry cough
School age , Chronic
cough, Dyspnea,
wheezing
Dyspnea, Chronic cough
wheeze
Wheezing , Dyspnea, Chronic cough
no fever
NO FEVER , WHEEZING , Dyspnea,
NOCTURNAL DRY COUGH
NO FEVER , Dry Cough
Chronic cough , wheezing
Examination
For Against
_
Chronic cough, Dyspnea,
wheezing
No previous same illness ,
Dry cough , nocturnal cough ,
no fever
No fever , there's no special
aggravating or relieving
factors
aggravated by smoke and
dust
No fever , no weight loss ,
no contact with TB Patient ,
Vaccinated
No fever , no weight loss ,
no h/o recurrent pneumonia , dry
nocturnal cough
No h/o of cardiac
disease
Wheezing , not disappearing
during sleep , relieved by
medications
• Afebrile , Dennie lines , No LAP
• pectus excavatum
• chest expansion ⬇
• Hyper resonant on percussion
• Equal air entry with diffuse
expiratory rhonchi.
• all positive finding
_
• chest expansion ⬇
• Hyper resonant on percussion
• Equal air entry with diffuse
expiratory rhonchi.
Ronchi
Decrease chest expansion
Afebrile , No LAP
chest expansion ⬇
Dullness , crepitation
Hyper resonant on percussion
• Afebrile, No LAP
• pectus excavatum
• Fine crepitation
None
• chest expansion ⬇
• Hyper resonant on percussion
• pectus excavatum
none
• Afebrile , No LAP
• pectus excavatum
• Afebrile, No LAP
• pectus excavatum
• Hyper resonant on percussion
• Equal air entry with diffuse
expiratory rhonchi.
• Equal air entry
• Afebrile, No LAP
• pectus excavatum
• chest expansion ⬇
• Hyper resonant on percussion
• Equal air entry with diffuse
expiratory rhonchi.
• chest expansion ⬇
• Hyper resonant on percussion
• Equal air entry with diffuse
expiratory rhonchi.
• all positive finding
• Afebrile _+ , body belt
• Equal air entry with diffuse
expiratory rhonchi.
• No clubbing
15. CASE SUMMARY
Ahmed is 10 years old with H/O cough more than 3 weeks
It was the first attack ,mainly aggravated by dust and smoke
With positive family history of atopy , his father is smoker
On examination :
he was completely well ,vital signs are stable, there is signs
of allergy and chest findings
Most likely diagnosis is
……………………………..
17. • CBC: eosinophilia
• Ig-E more than 8%
• CRP & ESR Normal
• CXR :
• - hyperinflated chest
- peribronchial cuffing
Sputum & C/S : Normal
18. Q5: What diagnostic investigations
needed to confirm or exclude the
diagnosis?
19. SPIROMETRY
Pulmonary function test
• FEV1/FVC ratio < 70%
• Decrease FVC & FEV1
• Increase RV
PEFR ( Peak Expiration Flow Rate ) 20% less
than predicted value for height
Bronchodilator response +VE (12% increase
in PEFR )
25. Management of acute asthma:
At home= 2 puffers Ventolin inhaler (salbutamol) every 2 mins
repeated until improved
If not improved:
Admitted to hospital :
1. Ventolin neb (salbutamol) every 20 min in the first hour
2. ipratropium bromide (atrovent nebulizer) 4/hourly
If not improved
adrenaline neb
methyl prednisolone IV regular 6 hourly
Continue Ventolin neb /2hrs
Continue atrovent neb /4hrs
and
1. mg sulphate
2. I.V Ventolin infusion
3.Aminophline infusion
If not improved do chest X-ray to exclude complication as
pneumonia-pneumothorax
26.
27.
28. Q1: A CHILD WITH BOTH PARENTS ARE
ASTHMATIC HAVE A RISK TO BE BRONCHIAL
ASTHMA IS :
A) 50%
B) 25%
C) 30%
D) 10%
Quiz
29. Q: SIGNS OF ALLERGY MAY BE PRESENT IN
ALL OF THE FOLLOWING EXCEPT ?
A) MOUTH ULCER
B( TRANSVERSE NASAL CREASE
C) MOUTH BREATHING
D) ALLERGY SHINERS
E) DENNIE LINES
Quiz
30. Causes of wet or productive cough include all
of the following except :
a)Bronchial asthma
b)Bronchiectasis
c)Aspiration
d)Abscess
e)Cavitation
31. In management of actual sever bronchial asthma ,
the following is incorrect :
A. uses of oxygen almost in all patients.
B. Nebulizer B2- agonist plays an important role.
C. Systemic corticosteroids shorten the duration of
illness
D. Aminophylline consider as first line of therapy.
