Case

A 37 y/o black female with a history of asthma, presents to the ER with tachypnea, and acute shortness of breath with audible wheezing. Patient has taken her prescribed medications of Cromolyn Sodium and Ventolin at home with no relief of symptoms prior to coming to the ER. A physical exam revealed the following: HR 110, RR 40 with signs of accessory muscle use. Ausculation revealed decreased breath sounds with inspiratory and expiratory wheezing and pt was coughing up small amounts of white sputum. SaO2 was 93% on room air. An arterial blood gas (ABG) was ordered with the following results: pH 7.5, PaCO2 27, PaO2 75. An aerosol treatment was ordered and given with 0.5 cc albuterol with 3.0 cc normal saline in a small volume nebulizer for 10 minutes. Peak flows done before and after the treatment were 125/250 and ausculation revealed loud expiratory wheezing and better airflow. 20 minutes later a second treatment was given with the above meds. Peak flows before and after showed improvements of 230/360 and on ausculation there was clearing of breath sounds and much improved airflow. RR was 24 at this time and HR 108. Symptoms resolved and patient was given prescription for inhaled steroids to be used with current home meds. Instruction was given for use of inhaled steroids and the patient was sent home. This case is an example of what many people with asthma experience. The following discussion will cover the etiology, pathogenesis, signs and symptoms, diagnosis, and treatment of asthma. Complete the following sections and take the quiz to check your understanding.

Learning Objectives
After completing the sections below, you should be able to: 1. list different ways asthma is diagnosed. 2. explain how a proper forced expiratory test is to be performed. 3. list the 3 primary pathologic reactions during as asthmatic episode. 4. differentiate the two types of asthma. 5. recognize chest x-ray changes seen with asthma. 6. recognize the signs and symptoms of asthma. 7. describe some of the equipment necessary for an exercise test. 8. discuss why and how a bronchoprovocation test is done. 9. discuss which values are most often used when testing for asthma. 10. recommend the appropriate drug therapy of an asthmatic patient for chronic treatment or for an acute attack. 11. recognize the commonly used bronchodilation agents. 12. list the side effects related to the different asthma medications.

References
1. Guidelines for the Diagnosis and Management of Asthma - National Heart, Lung, and Blood Institute, National Asthma Education Program, Expert Panel Report 3, 2007. Latest Update and NHLBI Asthma Site 2. Marino, P. The ICU Book.Lea & Febiger. Philadelphia. 1991.

3. Ruppel, G. Manual of Pulmonary Function Testing - 6th ed. Mosby. St. Louis. 1994. 4. JAMA Asthma Information Center 5. ALA/ATS International Conference, April 1998 6. Wenzel, SE. Antileukotriene drugs in the management of asthma. JAMA. 1998; 280 (24); 2068-2069. 7. Barnes PJ, IM Adcock, How do corticosteroids work in asthma. Ann Intern Med. 2003; 139 (5: Part 1): 359-370.