Clinical manifestation : Asthma

Clinical manifestation

  • Recurrent episodes of wheezing, breathlessness, cough, and tight chest
  • Expiration may be prolonged.
    • Inspiration-expiration ratio of 1:2 to 1:3 or 1:4
    • Bronchospasm, edema, and mucus in bronchioles narrow the airways
    • Air takes longer to move out
  • Most common manifestations
    • Cough
    • Shortness of breath (dyspnea)
    • Wheezing
    • Chest tightness
    • Variable airflow obstruction

Complications and classification

  • Mild
    • Dyspnea occurs with activity and patient may feel that he or she “can’t get enough air.”
    • PEF ≥70%
    • Usually treated at home
      • Prompt relief with inhaled SABA such as albuterol (delivered via a nebulizer or MDI with a spacer)
      • Patients instructed to take 2 to 4 puffs albuterol every 20 min three times to gain rapid control of symptoms
      • Occasionally short course of oral corticosteroids is needed.
  • Moderate
    • Dyspnea interferes with or limits usual activities.
    • PEF 40%69%
      • Usually requires office or ED visit
      • Relief is provided with frequent inhaled SABA.
      • Oral systemic corticosteroids. (Symptoms may persist for several days even after corticosteroids are started.)
  • Severe exacerbations
    • Respiratory rate >30/min
    • Dyspnea at rest, feeling of suffocation
    • Pulse >120/min
    • PEFR is 40% at best
    • Usually seen in ED or hospitalized
      • Partial relief from frequent inhaled SABA
      • Oral systemic corticosteroids. Some symptoms last for >3 days after treatment is begun.
      • Adjunctive therapy: ipratropium, IV magnesium
  • Life-threatening asthma
    • Too dyspneic to speak
    • Perspiring profusely
    • Drowsy/confused
    • PEFR <25%
    • Require hospital care and often admitted to ICU
      • Minimal or no relief from frequent inhaled SABA
      • IV corticosteroids
      • Adjunctive therapy: ipratropium, IV magnesium

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