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Respiratory: Asthma - Coggle Diagram
Respiratory: Asthma
Signs + sx
wheeze
chest tightness
cough
Dyspnoea
atopic features
Hay-fever
eczema
rhinitis
diurnal variation (worse @ night)
Incomplete sentences
Accessory Muscle use
Tripoding
Purse-lip breathing
Drowsiness secondary to hypercapnia (life-threatening)
Peripheral Cyanosis
tachycardia
Pulsus paradoxus
tremor (SE of inhaled B-agonists)
Oral candidiasis from steroid use
Triggers
Smoking
Viral illnesses
Air pollution
Dust & Dust mites
Pets
Hay fever
Food allergies
Exercise
Weather changes
Investigations
Peak Flow Diary
Spirometry and reversibility test
Obstructive pattern (FEV1/FVC <0.7) with reversibility after salbutamol (FEV1 increased by 12% + 200mls)
Histamine/Metacholine Bronchoprovocation challenge
if -ve excl asthma
FBC
eosinophilia
WCC can indicate infective exacerbation
CRP
ABG
↓PaO2 and ↑ PaCO2 in severe/life-threatening
IgE RAST panel/skin prick to look for triggers
Management
vaccines
trigger avoidance
chest physio
Inhaler Therapy: stepwise approach (GINA guidelines)
SABA + low dose ICS-LABA combo (symbicort)
SABA + low dose ICS-LABA + LTRA (Montelukast)
SABA + medium dose ICS-LABA (Seretide)
SABA + ICS-LABA +/- Tiotropium +/- Biologics (Omalizumab) +/- PO steroids
of emergency asthma exacerbation...
Salbutamol 5mg Neb
Hydrocortisone 100mg IV
Add Ipratropium 0.5mg to nebulisers
Mg Sulphate IV over 20min single dose
ICU
ABCs
O2
Aetiology
reversible airway obstruction
Eosinophilic (allergic) vs Neutrophilic (steroid-resistent)
bronchoconstriction, mucus hypersecretion
Grading asthma exacerbation
Moderate
PEFR >50% of predicted
Severe
PEFR 33-50% of predicted
Lifethreatening
PEFR <33% of predicted