Wednesday, June 3, 2015
Asthma: Trigger factors and Therapy
Asthma 1. Exercise-Induced asthma 1) Short-acting beta agonist used 20 min prior to exercise are sufficient to prevent symptoms and are first-line therapy. 2) Long-acting beta agonists may be used in children or athletes who engage in athletic activities throughout the day. 2. Patients with adult-onset asthma and symptoms that are worse after meals, exercise, or laying down are likely to have GERD-induced disease.(3024) * GERD can exacerbate airflow obstruction in asthmatics through inceased vagal tone, heightened bronchial reactivity, and microaspiration of gastric contents into the upper airway. (4335) 3. Aspirin-induced asthma (4065) 4. Beta-2 agonists like albuterol → driving potassium into cells → reduced serum potassium → muscle weakness, arrhythmias, and EKG changes Other common side effects of beta-2 agonists include tremor, headache and palpitations. 5. Management of asthma 1) Medications for chronic asthma (4617) The most common adverse effect of inhaled corticosteroid therapy is oropharyngeal thrush. Glucocorticoid-induced neutrophilia by increasing the bone marrow release and mobilizing the marginated neutrophil pool. 2) Management of asthma exacerbation * Indicators of severe asthma attack include normal to increased Pco2 values, speech difficulty, diaphoresis, altered sensorium, cyanosis, and “silent” lungs.(4105) * Endotracheal intubation and mechanical ventilation are indicated in patients with severe asthma unresponsive to medications who have fatigue, altered mental status, CO2 retention, worsening hypoxemia, and poor air movement on examination. (3459) 6. The 3 most common causes of chronic cough (lasting >8weeks) are upper-airway cough syndrome(postnasal drip), asthma, and GERD. (4519) * Numbers listed in this article is the question id number from Uworld Qbank. * For further information, please check out Uworld Qbank using the question id number listed in the article.