ACu1L SLvL8L AS1PMA

AS1PMA
- AsLhma ls a syndrome characLerlzed by alrflow
obsLrucLlon LhaL varles markedly boLh
sponLaneously and wlLh LreaLmenL
9revalence
AffecLs approxlmaLely 300 mllllon people worldwlde
1012 of adulLs and 13 of chlldren affecLed by Lhe dlsease
AsLhma can presenL aL any age wlLh a peak age of 3 years
Chlldren lemale more Lhan male
AdulL lM 11
- AsLhmaLlcs harbor a speclal Lype of
lnflammaLlon ln Lhe alrways
Pence more responslve Lo a wlde range of
Lrlggers
excesslve narrowlng of bronchloles
consequenL reduced alrflow
wheezlng and dyspnea
narrowlng of Lhe alrways ls usually reverslble
Chronlc asLhma may have an elemenL of
lrreverslble alrflow obsLrucLlon
Jhen Lhe LherapeuLlc alms fall
Acu1 5vk A51nMA
lotleots ot tlsk of Jeveloploq oeotfotol ot
fotol ostbmo
9revlous nearfaLal asLhma eg prevlous
venLllaLlon or resplraLory acldosls
9revlous admlsslon for asLhma especlally lf ln Lhe
lasL year
8equlrlng Lhree or more classes of asLhma
medlcaLlon
Peavy use of beLa 2 agonlsL
8epeaLed aLLendances aL Lu for asLhma care
especlally lf ln Lhe lasL year
C||n|ca| Ieatures
ncreaslng chesL LlghLness
Jheezlng
Dyspnea that are often not or poor|y re||eved by the|r usua|
re||ever |nha|er
am|nat|on
unable Lo compleLe senLences
CyanoLlc
1achypnea
PyperlnflaLlon
1achycardla
9ulsus paradoxus
p|rometry
Marked fall ln splromeLrlc values and 9Ll
ArLerlal blood gases on alr show hypoem|a
9
CC2
ls usually low due Lo hypervenLllaLlon
A norma| or r|s|ng
CC2
ls an lndlcaLlon of
lmpendlng resplraLory fallure and requlres
lmmedlaLe monlLorlng and Lherapy
A chesL roenLgenogram ls noL usually
lnformaLlve buL may show pneumon|a or
pneumothora
evels of sevetlty of ocote ostbmo exocetbotloos
-earfata| asthma
8alsed 9aCC 2
and/or
requlrlng mechanlcal venLllaLlon wlLh ralsed
lnflaLlon pressures
|fe threaten|ng asthma
Any one of Lhe followlng ln a paLlenL wlLh severe
asLhma
C||n|ca| s|gns
W AlLered consclous level
W LxhausLlon
W ArrhyLhmla
W PypoLenslon
W Cyanosls
W SllenL chesL
W 9oor resplraLory efforL
easurements
W 9Ll 33 besL or predlcLed
W SpC2 92
W 9aC2 8 k9a
W normal" 9aCC 2 (4660k9a)
Comp||cat|ons of acute asthma
- 9neumoLhorax medlasLlnum
perlcardlum subcuLaneous emphysema
- Mucus plugglng aLelecLasls
- LacLlc acldosls
- Myocardlal lnfarcLlon
- Anoxlc braln damage
- 1heophylllne LoxlclLy
- LlecLrolyLe dlsLurbances
anagement
CkG-
lve supplemenLary oxygen Lo all
hypoxaemlc wlLh acuLe severe
asLhma Lo malnLaln an spo2 level of
9498
|ghdose short act|ng beta 2 |nha|ed
agon|sts(A8A)
flrsL llne of managemenL
admlnlsLer early as posslble
reserve lnLravenous agonlsLs for
Lhose paLlenLs ln whom lnhaled
Lherapy cannoL be used rellably
nebullzers and Mu wlLh spacers
are preferred
- An lnhaled anLlchollnerglc
pratrop|um brom|de (03mg every 4
Lh
Lo 6 Lh hourly) may be added lf Lhere ls noL a
saLlsfacLory response Lo

agonlsLs alone
- 8efracLory Lo lnhaled Lheraples a s|ow
|nfus|on of am|nophy|||ne may be effecLlve(3
mg/kg loadlng dose over 20 mlnuLes followed
by lnfuslon of 0307 mg/kg/hr)
- Magnes|um su|fate glven lnLravenously (122
g v lnfuslon over 20 mlnuLes )or by
nebullzer when added Lo lnhaled
2
agonlsLs
rophy|act|c |ntubat|on
lmpendlng resplraLory fallure
anesLheLlc such as haloLhane
edat|ves depress vent||at|on
AnLlbloLlcs noL used rouLlnely un|ess there
are s|gns of pneumon|a
@CD @A
8educe morLallLy relapses subsequenL
hosplLal admlsslon and requlremenL for
agonlsL
G|ve stero|ds |n adequate doses |n a|| cases of
acute asthma
IA @C -@-I CA
ueLerloraLlng 9Ll
9erslsLlng or worsenlng hypoxla
Pypercapnea
ArLerlal blood gas analysls showlng fall ln 9h
LxhausLlon feeble resplraLlon
urowslness confuslon alLered consclous sLaLe
8esplraLory arresL
- nCnnvASvL vLn1LA1Cn
- 1Mn Cl uSCPA8L
9aLlenLs dlscharged wlLh 9Ll 73 besL or
predlcLed and wlLh dlurnal varlablllLy 23
are aL greaLer rlsk of early relapse and
readmlsslon
- 9A1Ln1 LuuCA1Cn
- lCLLCJ u9
efractory asthma
AsLhma noL conLrolled by regular medlcaLlons
needlng oral corLlcosLerolds for
managemenL
perslsLenL sympLoms and poor lung
funcLlon desplLe approprlaLe Lherapy
normal or near normal lung funcLlon buL
lnLermlLLenL
severe (someLlmes llfeLhreaLenlng)
exacerbaLlons
Causes
1noncompllance Lo CS
2 Chronlc lnfecLlon wlLh Mycoplosmo
poeomooloe or cblomyJopbllo
poeomooloe
3Chronlc rhlnoslnuslLls
4 8eLaadrenerglc blockers asplrln and
oLher cyclooxygenase (CCx) lnhlblLors
3 Pyper and hypoLhyroldlsm
Cort|costero|des|stant Asthma
varlous molecular abnormallLles LhaL lmpalr
Lhe anLllnflammaLory acLlon of
corLlcosLerolds
CompleLe reslsLance Lo corLlcosLerolds
L ls deflned by a fallure Lo respond
Lo a hlgh dose of oral
prednlsone/prednlsolone (40 mg once
dally over 2 weeks)
@reatment of res|stant asthma
Cmallzumab
8r|tt|e Asthma
ChaoLlc varlaLlons ln lung funcLlon desplLe
Laklng approprlaLe Lherapy
@ype br|tt|e asthma
9erslsLenL paLLern of varlablllLy
requlre oral corLlcosLerolds or
conLlnuous lnfuslon of
2
agonlsLs
@ype 2 br|tt|e asthma
normal or nearnormal lung funcLlon
preclplLous unpredlcLable falls ln lung
funcLlon LhaL may resulL ln deaLh
@reatment SubcuLaneous eplnephrlne