14 Questions
What is the primary goal of the emergency clinician in treating acute severe asthma?
Preventing intubation
What is the prevalence of asthma in the general population in Egypt?
6.7%
What is the effect of age on the risk of asthma?
The risk increases with age
What is the characteristic of asthma that leads to recurrent episodes of symptoms?
Hyperresponsiveness
What is the number of people affected by asthma in the United States?
26 million
What is the primary cell type involved in asthma pathophysiology?
Mast cells
What is the status of Miss. Poor Compliance's asthma?
Brittle
What is the number of deaths attributed to asthma in 2006 in Egypt?
406
What is the primary cause of airflow obstruction in asthma?
Contraction of the airway smooth muscle and swelling of the airway wall
What is the characteristic of near fatal asthma (NFA) associated with eosinophilic inflammation?
Gradual deterioration over days-weeks
What is a marker of severe asthma?
Pulsus paradoxus (>15mmHg decreased with inspiration)
What is the characteristic of the 'Silent Chest' in severe asthma?
Quiet chest on auscultation
What is the characteristic of near fatal asthma (NFA) associated with neutrophilic inflammation?
Rapid onset and response to therapy
What is a clinical sign of severe asthma?
Cyanosis and sweating
Study Notes
Asthma Definition and Epidemiology
- Asthma is a chronic inflammatory disease of the airways characterized by hyperresponsiveness, mucosal edema, and mucus production.
- Approximately 26 million people in the United States have asthma.
- In Egypt, the incidence rate of asthma is approximately 6.7% among the general population.
- Asthma impacts both men and women, with a higher prevalence observed in females.
- The risk of asthma tends to increase with age.
- Asthma is the most common chronic disease in childhood.
Asthma Pathophysiology
- Asthma is a chronic inflammatory disorder of the airways involving many cells and cellular elements, including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells.
- Inflammation in asthma causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing.
- Airflow obstruction in asthma results from contraction of the airway smooth muscle and swelling of the airway wall due to smooth muscle hypertrophy and hyperplasia, inflammatory cell infiltration and edema, goblet cell and mucous gland hyperplasia with mucous hypersecretion, protein deposition including collagen, epithelial desquamation, and near fatal asthma (NFA).
Near Fatal Asthma (NFA)
- NFA is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide level greater than 50mmHg, with or without altered conscious state.
- Two distinctive phenotypes of NFA have been identified: eosinophilic inflammation associated with gradual deterioration over days-weeks, and neutrophilic inflammation with rapid onset and response to therapy.
Markers of Severe Asthma
- End of the bed test: inability to speak in full sentences, use of accessory muscles or tracheal tugging, cyanosis, and sweating.
- Clinical signs: pulsus paradoxus (>15mmHg decreased with inspiration), quiet chest on auscultation, confusion or decreased level of consciousness, hypotension or bradycardia.
- Objective measurements: FEV1.
Case Study
- A 25-year-old lady, Miss Poor Compliance, is rushed into the Emergency Department with severe asthma, having been given 3x 5mg salbutamol nebs and 0.5mg of adrenaline IM prehospital.
- She is sitting forward in the tripod position, using her accessory muscles to breathe, and is tachypneic, agitated, and unable to talk.
- Vital signs: pulse 143, BP 138/95, RR 42, Sp02 91% on neb, GCS 14/15.
Asthma is a chronic inflammatory disease of the airways characterized by symptoms of cough, chest tightness, wheezing, and dyspnea.
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