Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert
RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7975293. Accessed July 6, 2012.
- Chronic inflammatory disorder of airways that causes recurrent
episodes of wheezing, breathlessness, chest tightness, and coughing.
- Major characteristics:
- Airflow obstruction
(related to bronchospasm, edema, and hypersecretion)
- Bronchial hyperresponsiveness (BHR)
- Airway inflammation
- Inhaled allergen causes activation of B lymphocytes, mast
cells, and macrophages, which release proinflammatory mediators
such as histamine and eicosanoids that induce contraction of airway smooth
muscle, mucus secretion, vasodilation, exudation, and edema with
reduced mucus clearance.
- Activation of eosinophils, T lymphocytes, basophils, neutrophils,
and macrophages cause further release of inflammatory mediators
such as leukotrienes, interleukins, histamine, platelet-activating
factor (PAF), and chemotactic factors.
- Affects 22.9 million persons in the United States.
- Most common chronic childhood disease, affecting approximately
6.7 million children.
- Accounts for 1.6% of ambulatory care visits (10.6
million physician office visits and 1.2 million hospital outpatient
- Resulted in 440,000 hospitalizations and 1.7 million emergency
department (ED) visits in 2006.
- Accounts for >12.8 million missed school days per year.
- Genetic predisposition
- Socioeconomic status
- Exposure to secondhand tobacco smoke in infancy and in utero
- Allergen exposure
- Respiratory syncytial virus infection
- Decreased exposure to common childhood infectious agents
- Chronic asthma
- Symptoms: Episodic dyspnea
with wheezing, chest tightness, and coughing that may occur spontaneously,
with exercise, or after exposure to known allergens
- Signs: Expiratory wheezing; dry, hacking cough; atopy (e.g.,
allergic rhinitis, eczema)
- Can vary in frequency from intermittent to chronic daily symptoms.
- Severity determined by lung function, symptoms, nighttime
awakenings, and interference with normal activity.
- Acute severe asthma
- Symptoms: Anxiousness
with acute distress and complaints of severe dyspnea, shortness
of breath, and chest tightness unresponsive to usual measures
- Signs: Expiratory and inspiratory wheezing; dry, hacking cough;
tachypnea; tachycardia; pallor or cyanosis; hyperinflated chest
with intercostal and supraclavicular retractions
Means of Confirmation
- Chronic asthma
- History of recurrent episodes
of coughing, wheezing, chest tightness, or shortness of breath and confirmatory
- May be family history of allergy or asthma, or patient symptoms
of allergic rhinitis.
- History of exercise or cold air precipitating symptoms during
specific allergen seasons.
- Acute severe asthma
- History of previous asthma
exacerbations (e.g., hospitalizations, intubations) and complicating illnesses
(e.g., cardiac disease, diabetes).
- Assess hydration status; use of accessory muscles of respiration;
and presence of cyanosis, pneumonia, pneumothorax, pneumomediastinum,
and upper airway obstruction.
- Obtain complete blood count (CBC) when fever or purulent
- In acute severe asthma, arterial blood gases may reveal metabolic
acidosis and low partial pressure of oxygen (PaO2).
- Chest radiography in patients with fever to rule ...
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