Asthma Physiology Pathophysiology Chronic, reversible, narrowing of airways caused by bronchospasm, inflammation and increased secretions Episodic Bronchial

onchial hyperresponsiveness Airway inflammation Triggers Allergens Irritants Cold air, dry air, fine airborne particles

Exercise Microorganisms Aspirin Clinical manifestations

Wheeze Increased respiratory rate Breathing cycle longer Increased work of breathing Cough Use of accessory muscle to breathe Retractions Low O2 sat Altered level of consciousness Tachycardia Stepwise Severity

1. Mild Intermittent <2/wk, sx free between,<2/mo @ noc PEF 80% of nl, PEF variability <20%

2. Mild Persistent >2/wk, not daily, >2/mo @ noc, activity affected, PEF variability 20-30%

3. Moderate Persistent

Daily, >2/wk, may persist for days, 1/wk @noc at least, PEF variability >30%

4. Severe Persistent Continuously present, PEF <60% nl, freq @noc, activity limited, PEF variability >30% Diagnosis PFT using spirometry FEV1 or PERF Decrease in either of 15-20% below the expected value for age, gender and size. Increase of 12% after treatment w/bronchodilators Methacholine Measure before & after - bronchospasm Goals of Care National Asthma Education and Prevention Program Prevent troublesome symptoms, including nocturnal symptoms Maintain (near-) normal lung function

Maintain normal activity levels (including exercise and other physical activity). Not miss work or school due to asthma symptoms Prevent recurrent exacerbations of asthma and minimize the need for emergency department visits or hospitalizations Provide optimal pharmacotherapy with least amount of adverse effects Meet patients and families expectations of and satisfaction with asthma care

Treatment Education Medications Lifestyle management Oxygen Asthma action plan Step system Avoid triggers Peak Flow Zones Green Yellow >80% of expected or personal best

 Red

>50% of expected or personal best

<50% of expected or personal best Status Asthmaticus

Severe, persistent life- threatening Refractory to regular treatment Can lead to respiratory failure Hypoxemia, hypercapnia, respiratory acidosis and inability to ventilate Requires intubation, mechanical ventilation and aggressive pharmacologic interventions