Asthma Revision

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  • Asthma Case Study (pediatrics)
    • Pathophysiology
      • 1. Nathan has had a cough for several days & is febrile
        • 2. His asthma is a secondary response to an viral infection
          • 3. Subsequent localisation of IgE
            • 4. Asthma type: Extrinsic Atopic asthma caused by allergens
    • Underlying Cause of the Asthma
      • 1. Exposed to Allergen on his camping trip
        • 2. The antigens cross the bronchial epithelium
          • 3. Engulfed by dendritic cells, which attract T helper 2 cells to the lungs
            • 4. T 2 helper cells stimulate plasma cells to produce IgE
              • 5. Binds to receptors on Mast cells to produce histamine, which causes vasodilation, oedema and bronchospasm
    • Asthma Rating
      • SEVERE
        • Agitated, Increased work of breathing, Tachycardia, Marked limitation to talk
    • Paradoxical Chest Wall Movement
      • 1. Inward movement on inspiration and outward movement on expiration
        • 2. Significant negative inspiration pressures
          • Muscle imbalance between respiratory muscles
    • Why do people develop Use of accessory muscles
      • Intercostal, subcostal or sternal retraction reflects the negative pressure
        • In young infants this could manifest to head bobbing
    • Audible Wheeze
      • Combined swelling, increased mucous production and bronchial hyper responsiveness causes airway constriction
        • Breathing becomes difficult and as air passes through smaller spaces, a whistling sound appears
          • Often expiratory but can be both inspiratory and expiratory
      • No Audible Wheeze?
        • A tight chest might not wheeze at all
          • Patients who are fatigued dont wheeze
            • A sign of impending respiratory failure
    • Medications
      • Salbutamol: Relief of reversible Bronchospasm
        • Ipratropium: Chronic Asthma
          • Aminophylline: Prevention of reversible bronchospasm
            • Corticosteroid: Prophylactic management of asthma
              • Action: Reverse the process of bronchial asthma
                • Contraindications: Cataracts, Weight Gain, Oral thrush
            • Action: Non selective adenosine receptor antagonist
              • Contraindications: Tachycardia, Tremor, Nausea
          • Action: Anticholinergic
            • Contraindications: Headache, nausea, dry mouth
        • Action: Short acting B2 agonist, Smooth muscle relaxant
          • Contraindications: Tachycardia, tremor


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