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Asthma

Definition
  • A chronic inflammatory disorder of the airways resulting in recurrent and reversible bronchoconstriction.
Etiology
  • Allergens: Pollen, dust mites, pet dander.
  • Occupational: Chemicals, dust, fumes.
  • Respiratory infections.
  • Exercise.
  • Drugs: NSAIDs, beta-blockers.
  • Gastroesophageal reflux disease (GERD).
Clinical Presentation
  • Episodic breathlessness.
  • Wheezing.
  • Cough, often nocturnal.
  • Chest tightness.
Investigations
  • Spirometry: Reduced FEV1/FVC ratio, reversibility with bronchodilator.
  • Peak expiratory flow rate (PEFR) monitoring.
  • Allergy testing.
  • Blood tests: eosinophil count, IgE levels.
Management
  • Relievers: Short-acting beta-agonists (SABA) e.g., salbutamol.
  • Preventers:
    • Inhaled corticosteroids (ICS) e.g., beclomethasone.
    • Long-acting beta-agonists (LABA) e.g., formoterol.
    • Leukotriene receptor antagonists e.g., montelukast.
  • Acute severe asthma (Asthma attack):
    • Oxygen.
    • Nebulised SABA.
    • Systemic corticosteroids.
  • Education and self-management: asthma action plan.
Complications
  • Status asthmaticus (severe asthma not responding to treatment).
  • Chronic obstructive pulmonary disease (COPD).
  • Respiratory failure.
Prognosis
  • Variable. Most have good control with treatment, but some may progress to chronic respiratory impairment.

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