Asthma ( Part 2 ) Dr.kassim.M.sultan F.R.C.P

Case scenario of asthma

25 years old female presented to you at the accident and emergency unit with dry cough, dyspnea, wheeze for 6 days and she had similar attack many times in the last 4 years. Also she had a history of allergic rhinitis. family history revealed similar condition in her mother.

On examination: Pulse rate 110/minute regular Blood pressure 120/80 mmHg Respirator rate 26 cycle/minute Central cyanosis Examination of chest was normal apart from hyper inflated chest, using accessory muscles of respiration ( sternomastoid and intercostal muscles) .normal vescular breath sound with diffuse expiratory rhonchi and prolonged expiratory phase.

Questions with Answers

Q1 What are the main symptoms of asthmatic patient? A Dry cough, dyspnea, chest tightness and wheeze. Q2 Do the symptoms get worse during the day? A the symptoms get worse during early morning. Q3 Is it necessary to ask about allergic conditions in patient and his family( eczema, urticaria and allergic rhinitis)? A Yes.

Q5 Regarding family history what question you are going to ask? Q4 What other aggravating factors that predispose to asthma? A Exposure to the followings: cats, dogs, cockroaches, horses, house dust mite, fungii and dust, Drugs ( aspirin, B-blockers, non steroidal anti inflammatory ). Q5 Regarding family history what question you are going to ask? A Ask about any other allergic conditions (eczema, urticaria, allergic rhinitis).

Q6 How you can diagnose asthma? A 1-History 2-Clinical examination: normal, hyperinflation, diffuse expiratory rhonchi and prolong expiratory phase and cyanosis in severe asthma. 3- Signs of severity of asthma (Inability to complete sentences in 1 breath , cyanosis, silent chest, change in consciousness level, tachycardia ≤ 125 beats/min., tachypnea ≤ 25 cycle/min.). 4-Investigations ( Spirometer and reversibility test, Peak flow meter, pulse Oximeter ( SPO2 < 92% ) for severe asthma).

Q7 How can you treat a case of asthma? A 1-Avoidance of aggravating factors. 2-Inhaled ( short acting B2-agonist salbutamol …) 3-Inhaled steroid (beclomethasone, fluticasone and budesonide ). 4-Oral leukotriene receptors antagonist (Montelukast). 5-Inhaled combination of long acting B2-agonist (formetrol and salmetrol ) with steroid. 6-Systemic steroid.

Q8 What are the complications of acute asthma? A 1-Collapse. 2-Pnumothorax. 3-Respiratory failure. 4-superadded infection. Q9 What are the indications for assisted ventilations? A Exhaustion confusion drowsiness coma respiratory arrest

Thanks for your listening