A 33 year old gentleman with longstanding asthma

A 33 -year old gentleman with long-standing asthma presents to the ER reporting 1 week of wheezing & chest tightness following upper respiratory tract infection. The patient is in moderate distress & is speaking in short sentences only. He has temperature of 37. 2 , pulse 120 per min. , respiratory rate 40 per min. , BP 110/60 , pulsus paradoxus of 10. His O 2 saturation on room air 90%. Inspiratory & expiratory wheeze are heard throughout the lung fields. The PEF is 40% of the predicted value & ABG study showed PH 7. 38, Pa. CO 2 42 mm. Hg , Pa. O 260 mm. Hg. After 1 hour of aggressive treatment with glucocorticoids, albeterol & ipratropium, the PEF is 60% of the predicted value & ABG: PH 7. 44, Pa. CO 2 36 mm. Hg, Pa. O 2 68 mm. Hg.

A chronic airway inflammation & hyperresponsiveness. It is a reversible airway disease.

- cough (productive) - wheeze - chest tightness & dyspnea (deficulty in breathing).

-exposure to allergens -dust - cold air -respiratory infection -exercise -gastroeosophogeal reflux -sinusitis -drugs: beta blockers, anaphylactic reactions

Mild, PEF 76 -100% of predicted. Moderate, PEF 50 -75% of predicted. Sever, PEF less than 50% of predicted.

A life threatening condition , features are: -silent chest cyanosis -bradicardia or arrhythmia -hypotension -exhaustion -confusion -coma -Pa. O 2 less than 60 mm. Hg -normal or increased Pa. CO 2

Respiratory Function: FEV 1 × 100 = less than 60% FVC Reversible spontaneously or in response to bronchodilators.

-O 2 -hydration -bronchodilators: -beta-agonists -ipratropium -anti-inflamatory: -steroids -interleukins antagonists -magnesium sulfate -theophyllins

Avoid triggering agents steroids brnchodilators mast cell stabilizers.