Understanding Asthma: Symptoms and Diagnosis

Asthma

• Asthma is a chronic, inflammatory, obstructive, non-contagious airway disease.
• Asthma varies in severity and is characterized by exacerbations of wheezing and coughing.
• Asthma episodes occur when a patient is exposed to a specific trigger, which can include dust, grass, pollen, smoke, and animal dander.

Patient Assessment

• Shortness of breath presents as pursed-lip breathing and chest tightness.
• Chest appearance includes an increased A-P diameter during an episode.
• Respiratory pattern includes accessory muscle usage and retractions, especially in children.
• Diagnostic chest percussion produces a hyperresonant/tympanic note.
• Breath sounds include diffuse wheezing, diminished breath sounds, and prolonged expiration.
• A physical appearance is diaphoresis.
• Vital signs include tachycardia, tachypnea, and pulsus paradoxus during severe episodes.

Diagnostic Testing

• A chest X-ray during an acute episode shows an increased A-P diameter, translucent (dark) lung fields, and depressed or flattened diaphragms.
• Arterial blood gas initially shows acute alveolar hyperventilation with hypoxemia, and may later develop hypercarbia in status asthmaticus.
• Spirometry reveals reduced flowrates, specifically in Peak Flow, FEV1, FEV1/FVC, and FEF25-27%.
• Post-bronchodilator spirometry indicates a significant response if FEV1 increases by at least 12% and 200 mL.
• During a Bronchial Provocation Test, FEV1 decreases significantly when a provocative agent, like inhaled methacholine, is introduced.

Treatment/Management of Acute Episodes

• Administer oxygen therapy.
• Perform aerosol therapy with SABA and anticholinergic agents, while considering continuous aerosol therapy.
• Use corticosteroids, either oral or IV.
• Closely monitor the patient.
• Intubation and mechanical ventilation may be required if ventilatory failure or respiratory arrest occurs.
• Consider adjunct therapies such as heliox therapy, magnesium sulfate, or subcutaneous epinephrine.

Long Term Control of Asthma

• Key to long term control is eliminating, minimizing, or avoiding asthma triggers to prevent acute attacks.
• Control medications include LABA, inhaled corticosteroids, mast cell stabilizers, and leukotriene inhibitors.
• The asthma action plan should be based on peak flow monitoring

Referral Considerations

• Refer patients to a physician specialist when there is difficulty confirming an asthma diagnosis.
• Referrals are also needed for suspected occupational asthma.
• Persistent uncontrolled asthma or frequent exacerbations warrants specialist referral.
• Refer patients for any risk factors for asthma-related death.
• Refer if there is evidence of, or risk for, significant treatment side effects.

References for Evidence-Based Practice:

• National Asthma Education and Prevention Program (NAEPP) is a reference for evidence-based practice.
• Global Initiative for Asthma (GINA) serves as a reference for evidence-based practice.

Explore the characteristics, patient assessment techniques, and diagnostic testing methods associated with asthma. Learn to identify triggers, assess breathing patterns, and interpret chest x-rays. Gain insights into managing this chronic inflammatory airway disease.