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Acute asthma Exacerbation (Risk Factors (Previous exacerbation, exposure…
Acute asthma Exacerbation
Pathophysiology
These inflammatory mediators cause vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction and mucus secretion from mucosal goblet cells with narrowing of the airways and obstruction of airflow
Plasma cells produce antigen-specific IgE, which crosslink with the antigen causing mast cell degranulation with the release of inflammatory mediators
antigen exposure to the bronchial mucosa activates dendritic cells, which present antigen to T-helper cells which differentiate into Th2 cells releasing inflammatory cytokines and interleukins that activate B lymphocytes and eosinophils
Epidemiology
African Americans and hispanics are more likely to be hospitalized than whites
More common in females than males after puberty
hospitalization rates higher in blacks and children
death rates higher in blacks aged 15-24 years
Diagnosis
patient history
peak flow measurement
oxygen saturation
short acting bronchodilator trial
ABGs
chest xray
Risk Factors
Previous exacerbation
exposure to allergens/irritants (i.e. cigarette smoke)
obesity
inhalant allergens (i.e. dust mites)
medications
extreme weather temperatures
exercise
respiratory infection
atopy
Clinical Presentation
Shortness of breath
Chest tightness
coughing/wheezing
prolonged expiration
tachycardia
Tachypnea
Treatment
short-acting beta 2 agonist
corticosteroids (oral or inhaled)
inhaled anticholinergic
antibiotic therapy (if bacterial cause)
oxygen therapy