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Bronchial Asthma - Coggle Diagram
Bronchial Asthma
Clinical picture:-
Symptoms:-
- The onset of attacks usually in early morning (high vagal tone)
- Triad of wheeze, non productive cough & dyspnea
- Associated:- anxiety, chest tightness or chest pain may be present
- At the end of the attack a small amount of viscid sputum (mucous pellets)
may be expectorated.
- The attacks resolve spontaneously or with therapy.
Signs:
A- Signs of airway obstruction:-
- Breath S:- Vesicular breath sounds with prolonged expiration.
- Add. S:-
- Generalized rhonchi, mainly expiratory, usually sibilant & polyphonic.
- Crepitations may occur (expiratory & changing with cough)
- Accessory muscle of expiration:-
B- Signs of hyperinflation :-
- Barrel shape chest – Hyper resonance – Low diaphragm
In between the attacks the chest is usually free.
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Differential Diagnosis:-
- Upper airways
- Vocal cord dysfunction
- Neoplasm
- Infection (diphtheria)
- Laryngeal:- edema, spasm
(tetany), malacia - web
- Vascular and other lesions
- Cardiac asthma
- Vasculitis:- PAN
- 1ry pulmonary hypertension
- Vascular rings
- Carcinoid syndrome
- Lower airways
- COPD
- Bronchial neoplasm
- Aspiration of foreign bodies
- Aspergillosis
- Cystic fibrosis
- Mediastinal masses
- Loeffler syndrome
- Bronchiolitis syndromes
- Bronchiectasis
- Sarcoidosis
- Amyloidosis
- Bronchopulmonary dysplasia
Paroxysmal dyspnea: (AHLAM) - Asthma (bronchial, cardiac, uraemic) -Hysterical -
Laryngismus stridulus (Tetany) - Allergic alveolitis - Myasthenia crises
Treatment
A- General roles:-
Avoidance of exposure to triggering factors
Treatment of respiratory infections : if present
Treatment of upper respiratory infections: especially chronic sinusitis.
B- Management of acute asthmatic attack:
- Inhaled B2 - stimulant e.g. Salbutamol 2 puffs
- And/or aminophylline 250-500 mg slowly intravenously.
If there is no response considered as severe asthma
Management of severe attack (status asthmaticu):-
1 - Admission to hospital: preferably in respiratory ICU.
2 - B2 stimulants :- given by IPPB (intermittent positive-pressure breathing) or
neubulizer e.g. 5 mg salbutamol + O2
- OR- Salbutamol IV infusion 250 ug over 10 min
3- Aminophylline:- given by IV infusion
Loading dose: 5.6 mg/kg in 15-30 min followed by maintenance dose 0.6
mg/kg/h (After 36 hours: plasma level should be measured & the optimum
level is 10-20 ug/m)
4- If there is no response steroids are added
e.g. Methylprednisolone Na succinale 2 mg/kg IV followed by 1-2 mg/kg/6h
followed by oral prednisone 60 mg/d orally then the dose is reduced by 5 mg
every 3 days.
5- Subcutaneous epinephrine and terbutaline.
6- Oxygen inhalation: using nasal prongs or mask
7- Intravenous or oral fluids to correct dehydration
8- Correction of electrolyte imbalance
9- Resistant severe cases may require mechanical ventilation.
10- Other drugs
Magnesium infusion counteraction ca-mediated smooth-muscle spasm
Ketamine:
Heliox: mixture of helium and oxygen improve ventilation
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Complications:-
- Acute severe asthma (status asthmaticus)
- Allergic bronchopulmonary aspergillosis which may lead to proximal
Bronchiectasis, fibrosis or collapse
- Complications of severe cough
- Complications of therapy e.g. steroids
- Cor-pulmonale & right sided heart failure
- Growth retardation in children with severe cases
- Pneunothorax & pneumediastinum
- Pulmonary infections
- Respiratory failure