PHRM 514 - Asthma - Fall 2012 (1)

National institutes of health national heart lung and

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National Institutes of Health, National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. asthgdln.pdf. Published August 28, 2007. Accessed September 19, 2012.
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Signs of an Acute Severe Asthma Exacerbation n Expiratory and inspiratory wheezing on auscultation n Breath sounds diminished with severe obstruction n Dry hacking cough n Tachypnea n Tachycardia n Pale or cyanotic skin n Hyperinflated chest with intercostal and supraclavicular retractions Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Symptoms of an Acute Severe Asthma Exacerbation n Anxious in acute distress n Severe dyspnea, shortness of breath, chest tightness, or burning n Only able to say a few words with each breath n Symptoms unresponsive to usual measures (inhaled short acting β2 agonist administration) Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Diagnosis of an Acute Severe Asthma Exacerbation n Laboratory ¡ PEF (peak expiratory flow) and FEV1 less than normal predicted values (<40% considered severe) ¡ Decreased arterial oxygen ¡ O2 saturations by pulse oximetry ¡ Decreased arterial or capillary CO2 if mild, but in normal range or increased in moderate to severe obstruction n Other diagnostic tests ¡ Blood gases to assess metabolic acidosis (lactic acidosis) in severe obstruction ¡ Complete blood count if there are signs of infection (fever and purulent sputum) ¡ Serum electrolytes ¡ Chest x-ray if signs of consolidation on auscultation Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Exercise Induced Bronchospasm (EIB) n Drop in FEV1 >15% of baseline (pre- exercise) n Exact cause unknown n Heat and/or water loss play a role n More common in cold, dry air n Reflection of increased BHR n May only have EIB and no other abnormal pulmonary function Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Nocturnal Asthma n Worsening asthma during sleep n Decrease in pulmonary function between bedtime and awakening n Multiple factors may affect nocturnal worsening n Indicator of inadequately treated asthma and asthma severity Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Review
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Case n Chief complaint: “She coughs all night.” n HPI: Patient is a 6 year old female who presents to her pediatrician’s office. She was last seen in the office 2 years ago and was diagnosed with allergic rhinitis. Her mother states that the patient has been coughing, particularly at night, and is having trouble breathing especially when she plays outside and with their pet dog.
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