Asthma Management and Diagnosis Quiz

Asthma

• Asthma can present with bronchospasm, either idiopathic or triggered by allergens or cold air.
• A subset of asthma patients present only with a persistent cough, termed cough-variant asthma.
• Asthma can manifest alongside other allergic conditions, such as seasonal allergies, conjunctivitis, or eczema.
• Aspirin can induce asthma in individuals with sensitivity to aspirin by inhibiting COX and increasing leukotriene production. This triad is also called Samter's triad.
• During an asthma attack, expiratory phase is prolonged. Acutely, patients experiencing asthma show decreased CO2, increased pH, and unchanged bicarbonate levels. This is acute respiratory alkalosis, caused by increased breathing rate.
• Chronic bronchitis, in contrast, shows increased CO2 because of impaired CO2 diffusion in the lungs due to mucous buildup and hypoxic vasoconstriction.
• Acute asthma attacks can lead to type I respiratory failure, with decreasing respiratory rate and increase in CO2 levels. Eventually, type II respiratory failure results.
• Initial diagnostic step for patients with asthma is a spirometry test to determine expiratory curve.
• Methacholine challenge can also diagnose asthma as the allergen may constrict airways.
• Typical treatment for asthma includes beta-2 agonists (e.g., albuterol) for acute attacks and inhaled corticosteroids (e.g., fluticasone) for long-term management.
• Patients with frequent attacks (2+ per week) often require dual therapy, combining inhaled corticosteroids and beta-2 agonists.

Bronchiectasis

• Bronchiectasis is characterized by chronic dilation of the bronchial airways.
• Worldwide, Tuberculosis is a main cause of bronchiectasis. In Western Countries, cystic fibrosis is a major cause.
• The condition is often presented with excessive, foul-smelling sputum production.
• Clubbing of the fingers is a common observation in patients with bronchiectasis.

Atelectasis

• Atelectasis refers to the collapse of alveoli in the lung.
• This is a common complication following surgery, often occurring within the first 24 hours.
• Atelectasis presents as bibasilar shadows or opacities on chest X-rays with fever in the post-surgery patient.
• Obstructive atelectasis occurs distal to an obstruction.
• The most common cause of atelectasis is obstruction from tumor or foreign body.
• The onset of fever within 24 hours of surgery is a high-yield indicator for atelectasis in 2CK exams.

Obsessive Sleep Apnea (OSA)

• Characterized by periods of cessation of breathing during sleep.
• Risk factors include obesity, and age.
• Diagnosis is done through sleep studies (polysomnography).
• Chronic fatigue is often associated which leads to dysthymia or depression.

Anaphylaxis

• Acute allergic reaction, triggered by exposure to allergens.
• Presents with symptoms such as dyspnea, bilateral wheezing, tachycardia, and hypotension.
• Common causes are insect stings, medications, and foods.
• Treatment involves administration of intramuscular epinephrine and supportive care.
• Venom immunotherapy can reduce the chances of future events.

Scombroid

• This is food poisoning caused by bacteria in certain fish. The poisoning can mimic symptoms of allergic reactions, asthma, or anaphylactic shock and hence it is important for students to distinguish between Scombroid and allergic reactions.

Shellfish Allergy

• A Type I hypersensitivity (IgE-mediated) reaction to shellfish consumption.
• Symptoms include respiratory distress, and skin rashes.
• It is important to distinguish it from Scombroid.

Cystic Fibrosis

• It is also caused by mutations in the CFTR gene on chromosome 7.
• The main mutation is ΔF508 which causes abnormal CFTR protein folding.
• CFTR protein is a chloride channel which is important for secretion of mucus.
• In CF, the chloride channel is mislocalized, resulting in inspissated secretions in the lungs, digestive tract leading to pancreatic insufficiency.
• Meconium ileus; is the symptom that is seen in infants.
• Sweat test (sweat chloride > 60 mEq/L) is used for diagnosis.
• Secondary complications include nasal polyps, and recurrent pneumonias.

Primary Ciliary Dyskinesia (Kartagener Syndrome)

• The condition is often characterized by situs inversus (mirror-image organization of organs)
• Dynein arms causing impaired cilia function are the cause.
• Patients often have recurrent respiratory infections.

Primary Pulmonary Hypertension (PPH)

• This is characterized by pulmonary hypertension that is not caused by other conditions such as COPD or left heart failure.
• Mutations and dysfunction in the BMPR2 gene is the cause in most cases.
• Patients often have symptoms of dyspnea, fatigue, and edema.
• Elevated endothelin-1 levels are a characteristic feature.
• Bosentan (an endothelin receptor antagonist) is a treatment option.

Systemic Sclerosis (Scleroderma)

• An autoimmune condition characterized by fibrosis (scarring) of the skin and internal organs.
• The distinction between limited and diffuse scleroderma (CREST syndrome) subtypes is a key factor.
• Pulmonary fibrosis is a prominent feature which leads to pulmonary hypertension.

Sarcoidosis

• Characterized by the presence of non-caseating granulomas in multiple organs, notably the lungs.
• The condition can cause hypercalcemia due to inappropriate 1,25-(OH)2-D3 production.

Rheumatoid Lung

• Rheumatoid lung is a possible complication of rheumatoid arthritis.
• It's characterized by fibrosis and can lead to respiratory distress.
• Methotrexate, a medication used to treat rheumatoid arthritis, is associated with pulmonary fibrosis, as the most common cause.

Pulmonary Embolism (PE)

• This condition is due to thromboemboli that travels to the lungs obstructing pulmonary circulation.
• Risk factors include post-surgery, prolonged immobility, and certain underlying conditions.
• Sinus tachycardia is a common ECG finding, while S1Q3T3 is an atypical and non-essential pattern.
• Diagnosis is usually confirmed with spiral CT scans, and treatment typically involves heparin followed by a CT scan to assess the effect of the treatment.

Amniotic Fluid Embolism

• This is not directly initiated by a condition. It is a complication post-childbirth (rare), commonly following placental separation.
• It has an acute onset and can be fatal due to the sudden onset and the systemic inflammatory response.

Fat Embolism

• Fat emboli are a complication of fractures, particularly long bone fractures, with an acute onset.
• Common causes include trauma or long-bone fractures.
• The condition is characterized by dyspnea and petechiae or purpura( skin rash).

Air Embolism

• Air emboli enter the circulation, frequently occurring during procedures involving catheter insertion, or trauma to venous structures.
• Symptoms often involve respiratory issues and cardiovascular collapse.

Cholesterol Embolism

• This complication follows certain surgeries, especially involving the aorta and can impact the extremities of the body, producing a skin rash which is observed usually after a surgery.