Asthma

 

Disease:

Pathophysiology

Triad:

·      Airway swelling

·      Airway hyperreactivity

·      Mucous hypersecretion

Significance:

·      Small airway total diameter is very large

·      Symptomatic obstruction implies significance narrowing

Complications

·      Airway hyperreactivity -> laryngospasm, bronchospasm

·      Severe exacerbation -> T2RF

·      Severe longstanding disease ->fixed airflow obstruction

Associated

·      Atopic disease: allergic rhinitis, eczema

·      Samter’s triad (5-10%): asthma + nasal polyps + NSAID allergy

 

Diagnosis:

History

·      Likely story

Examination

·      Wheeze

Investigations

·      FER <0.8

·      ↓FEV1

·      Bronchodilator response >12% or >200mL

(N.B. episodic nature means spirometry can be normal between flares)

 

Assessment:

Questions

·      Severity

·      Optimisation

History

·      Current exacerbation

·      Frequency of symptoms

·      Nocturnal symptoms

·      SABA use

·      Limitation of activity

·      Frequency of exacerbations

·      Previous ICU admission

·      Previous intubation

Examination

·      General: ↑WOB, pursed lips

·      Vitals: normal unless real trouble

·      Chest: barrel chest, wheeze vs quiet

Investigations

·      PEFR

·      FEV1: mild >70%, mod 50-70%, sev <50%

·      FEF25-75

 

Feedback welcome at ketaminenightmares@gmail.com