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

2. Case scenario of asthma

3. 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.

4. 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.

5. Questions with Answers

6. 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.

7. 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).

8. 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).

9. 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.

10. 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

11. Thanks for your listening