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Asthma
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⚫ It is one of the most common types of obstructive airway
disorders , where patients usually suffer of inability to get air
into the lungs
⚫ It usually affects all age groups but mostly start at childhood.
Muscles Tightening muscles Very
around airway
Inflamed tight
lining of muscles Mucus
airway wall blocking
Airway airway
Very
small
airway
Inflamed
Narrower
swollen
airway Mucus airway wall
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“I can’t breathe, and my albuterol
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doesn’t seem to be helping! I have
been using it every hour for the last
six hours”
⚫ MM a non-smoker 34 years old housewife living with
her husband and 2 cats.
⚫ She suffers of asthma since her childhood.
⚫ Complains of coughing and shortness of breath
that awakens her at least two nights a week,
most mornings on awakening, she complains of
chest tightness
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⚫ She states she especially becomes short of breath when she exercises;
although she admits that her shortness of breath is not always
brought on by exercise and sometimes occurs when she is not
actively exercising.
⚫ Ht= 160cm, Wt= 84kg
Patient Profile
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⚫ Physical Examination:
⚫ General (GEN) Anxious-appearing female; moderate respiratory distress with
audible wheezing noted; unable to speak in complete sentences; hunched
forward
⚫ Vital signs (VS):
⚫ BP 134/78, HR 125, RR 35, T 37°C.
⚫ Her peak flows have been running between 180 L/min and 200 L/min today
(personal best = 400 L)
⚫ Chest X-Ray Hyperinflated lungs; no infiltrates
- Mild oral thrush
Patient Profile
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Medication History:
⚫ Fluticasone MDI, which she uses “most days of the week”.
⚫ Albuterol inhaler approximately 3–4 times per week over the
past 2 months
⚫ With no known allergies
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Diagnosis:
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Acute Asthma Exacerbation
of
Uncontrolled moderate Asthma
Laboratory Tests
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Test Patient values Interpretetion
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Hb 12.5 g/dl
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Hct 37%
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s. Cr 0.9 mg/dl
05-May-23
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Ph. Omnia ashraf 18
Problem list
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1. Acute Asthma exacerbation
2. Uncontrolled moderately persistent Asthma
3. Mild oral thrush
4. Borderline anemia
What information indicates the
presence of an acute asthma
exacerbation?
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?
Ph. Omnia Ashraf 22
What information indicates the
presence of an acute asthma
exacerbation?
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⚫ Her peak flows have been running between 180
L/min and 200 L/min today (personal best = 400 L)
⚫ HR >120 bpm
⚫ RR >30/min
⚫ Unable to speak in complete sentences
Management of acute Asthma ?
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?
GINA guidelines
ph,. Omnia ashraf 25
ph,. Omnia ashraf 26
Ph. Omnia Ashraf 27
Ph. Omnia Ashraf 28
If the doctor prescribed
prednisone,….
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Prescribed Recommendations
Prednisone Dose:
Monitoring parameters:
Ph. Omnia Ashraf 30
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What if only dexamethasone
available,
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⚫ what dose should be used? .................................
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What information indicates the
presence of an uncontrolled
chronic asthma?
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?
What information indicates the
presence of an uncontrolled
chronic asthma?
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⚫ Albuterol inhaler approximately 3–4 times per week over the past 2 months
⚫ coughing and shortness of breath that awakens her at least two nights a week,
most mornings on awakening, she complains of chest tightness
⚫ She states she especially becomes short of breath when she exercises; although
she admits that her shortness of breath is not always brought on by exercise and
sometimes occurs when she is not actively exercising
Ph. Omnia Ashraf 41
Goal of treatment of
Asthma
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Ph. Omnia Ashraf
Is LABA appropriate for this
patient or do you have other
recommendations?
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GINA guidelines
888890999
Ph. Omnia Ashraf 44
Ph. Omnia Ashraf 45
Develop a pharmacotherapeutic
treatment plan for this patient’s asthma if
she were to become pregnant
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⚫ GINA guidelines
Ph. Omnia ashraf 47
What factors may have contributed
to this patient’s poorly controlled
asthma and acute exacerbation?
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⚫ GINA guideline
Ph. Omnia Ashraf 49
What non-pharmacologic
therapies might be useful for
this patient?
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⚫ GINA guideline
Ph. Omnia ashraf 51
Asthma action plan
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⚫ Written individualised medication plan
⚫ Demonstration of proper device administration
⚫ offer peak flow meter if applicable
Asthma action plan
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Ph. Omnia ashraf
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Ph. Omnia ashraf
Asthma action plan
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Ph. Omnia ashraf
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57 05-May-23
