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ACUTE ASTHMA EXACERBATION (Clinical Manifestation (Agitation, Chest…
ACUTE ASTHMA EXACERBATION
Clinical Manifestation
Agitation
Chest tightness and chest pain
Intercostal retractions
Wheezing
Increased respiratory rate
Coughing
Increased pulse rate
Bronchospasm and shortness of breath
Decreased lung function (measured by FEV1, peak expiratory flow (PEF), PaO2 , PaCO2 , and arterial oxygen saturation (SaO2 ).
Pathophysiology
Exposure to trigger → crosslinking of IgE molecules → inflammatory mediator activation → vasodilation, increased capillary permeability, mucosal edema, bronchospasm, increase mucus production narrowing of airway and airflow obstruction → hyperinflation of lungs → hyperventilation → hypoxia →retention of CO2 → respiratory acidosis → respiratory failure
Risk factors
Other chronic disease (Gastroesophageal reflux disease, rhinitis e.t.c)
Medications (NSAIDs, beta-adrenergic receptor blockers)
Viral respiratory tract infections,
Emotional factors (stress),
Environmental allergens (pollens, insects, dust mites, animal allergens etc
Behavioral factors (smoking, obesity, exposures to irritants)
Genetics
Diagnostic tests
Peak Air Flow test: measure the expiatory rate
Chest x-ray (to evaluate bibasilar atelacisis, hypoventilations)
Spirometry: documents reversible decrease in forced expiratory volume (FEV)
EKG
Patient history: history of allergies, refurrent episodes of wheezing and dyspnea
Arterial blood gas analysis – to access the severity of exacerbation
Treatments
Antimuscarinics (bronchodilator eg., ipratropium bromide)
Corticosteroids (anti-inflammatory)
Selective beta2 agonists (bronchodilator eg., salbutamol)
Magnesium Sulphate (bronchodilator)
Oxygen therapy