Osce- asthma

 Asthma education
o Triggers: dust, animal hair, odors, URIs cold air, exertion and stress
o History
 Cough, dyspnea, episodic wheezing, and /or chest tightness. Historical
features suggesting sever asthma include a history of frequent ER visits,
intubations and PO steroid use. Symptoms often worse at night or early
morning.
o Physical Exam
 Tachypnea, tachycardia, prolonged expiratory duration , decreased O2 sat
(late sigh), decreased breath sounds, wheezing, hyperresonance, accessory
muscle use, and possibly pulsus parasoxus.
o Differential
 Kids: aspiration, broncholitis, bronchopulmonary dysplasia, CF, GERD,
vascular rings, pneumonia
 Adults: CHF, COPD, GERD, PE, foreign body, tumor, sleep apnea, anaphylaxis
o Treatment
 ABGs reveal mild hypoxia and respiratory alkalosis
 Normalizing in pCO2 in acute exacerbation warrents close observation ,
indicates impending failure
 Peak flow is diminished – spirometry demonstrates decreased FEV1.
 CBC may show eosinophilia
 CXR may show hyperinflation
 Definitive dx with bronchial hyperresponsiveness test with a methacholine
challenge.
o Treatment
 Acute: oxygen, bronchodilators, steroids
 Chronic: regularly inhaled bronchodilator and/or steroids, systemic steroids,
cromolyn, or theophylline.
 Avoid allergins/triggers