Asthma

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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99 Asthma

Instruction

Examine this patient’s chest.

Salient features

History

• Determine whether there is a reversible airway obstruction by history: whether the wheezing and breathlessness is reversible

• Tightness in the chest

• Recurrent cough

• Exacerbation of the cough or wheeze at night or after exercise

• Improvement of the cough or wheeze with bronchodilator therapy

• Fever, yellowish sputum

• History of atopy (eczema, hay fever)

• History of rhinitis, nasal polyps

• History of trigger factors such as cold air, emotion, vapors, dust, drugs (e.g. beta-blockers), pollution, viral infections, pets, pollen.

Examination

• Bilateral scattered wheeze

• Examine the sputum cup.

Comment on accessory muscles of respiration, tachycardia, pulsus paradoxus and whether the patient can speak sentences without stopping to take a breath.

Diagnosis

This patient has a history of hay fever and bilateral scattered wheeze (lesion) caused by bronchial asthma (aetiology), and is breathless at rest (functional status).

Questions

Mention a few trigger factors known to aggravate asthma

• Infection

• Emotion

• Exercise

• Drugs, e.g. beta-blockers

• External allergens.

What do you understand by the term asthma?

Asthma is an inflammatory disorder characterized by hyper-responsiveness of the airway to various stimuli, resulting in widespread narrowing of the airway. The changes are reversible, either spontaneously or through therapy. The inflammatory response includes T lymphocytes, mast cells and eosinophils, and it is associated with exudation of plasma, oedema, smooth muscle hypertrophy, deposition of matrix, mucus plugging and epithelial damage.

Advanced-level questions

What do you understand by intrinsic asthma?

Intrinsic asthma is of non-allergic aetiology and usually begins after the age of 30 years. It tends to be more continuous and more severe; status asthmaticus is common in this group.

What do you understand by extrinsic asthma?

Extrinsic asthma has a clearly defined history of allergy to a variety of inhaled factors and is characterized by a childhood onset and seasonal variation.

What are the indications for steroids in chronic asthma?

• Sleep is disturbed by wheeze

• Morning tightness persists until midday

• Symptoms and peak expiratory flows progressively deteriorate each day

• Maximum treatment with bronchodilators

• Emergency nebulizers are needed.

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