Condition Info - BotMed Application

ConditionName

Asthma

ConditionDescription

Symptoms

Dry, hacking cough, Nocturnal cough (only one sign, typical for younger patients); Chest Tightness; Anxiety;
SOB; Increased sputum production; Fever (sometimes);
Symptoms worse at night;
Symptoms at work: check environment;
Exercises induced asthma;
Family history of atopy (dermatitis, rhinitis);
Acute onset SOB relives with rest or use of bronchodilators

PhysicalFindings

End-expiratory wheeze, prolonged expiratory phase
Wheezing (DDx with CHF); Tachypnea; Tachycardia;
Expiratory phase of respiration increased:
I/E ratio decreases (normal 1:2)
Increased use of accessory respiratory muscles
Pulsus paradoxus
Cyanosis
Difficulty talking

ClinicalTests

Pulmonary function testing chest x-ray, oxygen saturation, bronchoprovocation, allergy testing
Reversible airway abstraction. 
Use bronchodilator for diagnostic purpose. 
Methacholine provocation – vasoconstrictor 
R/O: CHF;

Acute setting:
Best initial test during exacerbation: Arterial blood gas (ABG) 
Chest xray
Pulse oximeter

Chronic setting:
Most accurate test: peak expiratory flow(PEF) – chronic state decreased 
Methacholine challenge (if PEF are normal)

RiskFactors

Obesity
Others atopic dz
Low socioeconomic status
Family history
Allergies
Churg-Strauss syndrome
Medication: BB, NSAIDs;

IsRedFlag

IsNPLEX

Consequence

Causes of acute exacerbation:
Allergens (pollen, dust mites, cockroaches)
Respiratory infections
Weather changes (cold)
Exercises
Menses
Drugs: ASA, NSAIDs, BB, sulfites 
GERD
Stress
Environmental irritants (cold air, smoke)

ProgressionFromCondition

TreatmentOptions

PharmOptions

Mild:
FEV1>=80%
<=2 day/w < =2nights/m
Albuterol inhaled (SABA)

Mild persistent:
FEV1>=80%
>2 day/w > 2nights/m
Add  (ICS)
Mometasone
Trimcinolone

Moderate persistent:
Daily daytime episodes
>1 nighttime episode/week
FEV1 60-80%
Add (LABA)
Salmeterol

Severe persistent:
Continual daytime episodes
Frequent nighttime symptoms
FEV1<60%
Increase dose of ICS to max in addition to LABA and SABA

WebLink

https://www.merckmanuals.com/en-ca/professional/pulmonary-disorders/asthma-and-related-disorders/asthma