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ASTHMA

ASTHMA. Greek: short drawn breath, panting. DIAGNOSIS. Constitutional Asthma History: Young Breathlessness, wheezy night time, Exertional Bronchial irritability: allergens, provocants, non allergic +/- rhinitis, hay fever, eczema tend to +ve family history. INVESTIGATION.

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ASTHMA

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  1. ASTHMA Greek: short drawn breath, panting

  2. DIAGNOSIS Constitutional Asthma History: Young Breathlessness, wheezy night time, Exertional Bronchial irritability: allergens, provocants, non allergic +/- rhinitis, hay fever, eczema tend to +ve family history

  3. INVESTIGATION spontaneously Peak Flow Variability B2 agonist corticosteroid Serum, skin testing (atopic, allergic) CXR (all that wheezes is not asthma)

  4. MANAGEMENT – CHRONIC PERSISTENT ASTHMA • Avoidance of (a) allergen e.g. diet (b) B blockers, NSAID • Recognise (a) reflux associated asthma (b) pre-menstrual asthma (c) Occupational Asthma versus Work Related Asthma

  5. Therapy of C P Asthma British Thoracic Society Guidelines 5 steps – oral corticosteroid may be Introduced at any step to regain control, as short burst.

  6. Step 5 – Maintenance low dose oral oral corticosteroid • Step 4 - The also rans Theophylline, Leukotriene Antagonist, Intal, Nedocromil, anti IgE therapy • Step 3 – As step 2 + L.A.B.A.(combined) • Step 2 - Inhaled corticosteroid • Step 1 – Inhaled B2 agonist

  7. Management C P Asthma Review – Ask the right questions. Do you have A every day? Do you wake wheezy?. Patient Education – What do I do if I start waking at night breathless, if the blue inhaler does not work?

  8. Acute Severe Asthma Misnomer, better termed Slowly deteriorating preventable Asthma

  9. Asthma Severity Signs Tachypnoea Tachycardia Cyanosis Paradoxical lower chest movement Beware the silent chest

  10. Asthma Severity Tests • PEFR (% of best, % predicted) • Oximetry: P02 5.3 >10kPa Satn. 75 90 97% • Arterial blood gases: P02 low PC02 low beware normal/high PC02 4. CXR – limited use

  11. A.S. Asthma Treatment • Oxygen ?% • Nebulised B2 agonist/anticholinergic • Corticosteroid – intravenous oral • Deterioration – back to back nebuliser intravenous therapy B2 agonist, aminophylline intravenous magnesium • Monitor oxygen sats closely • Peak Flow Monitoring, up to 4 times/daily Note – NO SEDATION, NO ANTIBIOTICS

  12. Pre discharge do’s and dont’s • Asthma Nurse – Inpatient and Follow up • Regard every admission as a “failure” how can I prevent readmission? Compliance • Do not discharge until: no night waking no symptomatic peak flow variability nebulisers stopped for 24 hours

  13. Maintain on lowest possible doses of therapy preferably inhalers via a spacer. Advice on mouth rinsing/spitting out to limit hoarseness, dysphonia, oral candidiasis.

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