NEARFATALASTHMA.pptVIP

NEAR FATAL ASTHMA DANIEL A. NADER, D.O., F.C.C.P., F.A.C.P. NEAR FATAL ASTHMA 5,000 DEATHS PER YEAR LIFE THREATENING ATTACKS MORE COMMON AFRICAN-AMERICANS, WOMEN, INNER-CITY PATIENTS AT GREATEST RISK LARGELY PREVENTABLE, MAY OCURR IN ANY ASTHMATIC PREDISPOSING RISK FACTORS PRIOR SEVERE ATTACKS (ESPICIALLY THOSE REQUIRING ASSISTED VENTILATION) NONADHERANCE TO THERAPY AGE 40 YEARS TOBACCO SMOKING RISK FACTORS INADEQUATE USE OF INHALED STEROIDS HOSPITALIZATION DESPITE CHRONIC ORAL STEROID USE PSYCHIATRIC ILLNESS RECREATIONAL DRUG AND ALCOHOL ABUSE DIMINSHED ABILITY TO SENSE AND RESPOND TO AIRWAY OBSTRUCTION RISK FACTORS FREQUENT USE OF BETA AGONIST DRUGS INDEPENDENT RISK FACTOR FREQUENT USE IDENTIFIES POORLY CONTROLLED DISEASE PATHOPHYSIOLOGY MUCOUS PLUGGING VASCULAR DILATATION AIRWAY EDEMA DESQUAMATION OF AIRWAY EPITHELIAL CELLS BRONCHIAL SMOOTH MUSCLE HYPERTROPHY INFLAMMATORY CELLULAR INFILTATE PATHOPHYSIOLOGY DEATH FROM ASPHYXIA MUCOUS PLUGGING, BRONCHOCONSTRICTION, AIRWAY EDEMA HYPERINFLATION, AIR TRAPPING HYPOXIA: V/Q MISMATCH HYPERCARBIA: RESPIRATORY MUSCLE FATIGUE CLINICAL PRESENTATION VIRAL URI’S HEAVY ALLERGEN EXPOSURE NONADHEARANCE TO THERAPY AIR POLLUTION WEATHER CHANGE EMOTIONAL STRESS DRUGS: ASPIRIN, BETA BLOCKERS CLINICAL PRESENTATION 90% PRESNET AFTER SEVERAL DAYS OF WORSENING SYMPTOMS 10% RAPID DETERIORATION IN MINUTES OR HOURS CLINICAL PRESENTATION DYSPNEIC, ANXIOUS, DIAPHORETIC SITTING UPRIGHT TACHYCARDIC, TACHYPNEIC WHEEZING TO ABSENT BREATH SOUNDS USE OF ACCESSORY MUSCLES LABORATORY ELEVATED WBC INCREASED EOSINOPHILES INCREASED LACTIC ACID ABG VARIABLE CHEST RADIOGRAPH HYPERINFLATION EXCLUDE INFILTRATES, PULMONARY VASCULAR CONGESTION PNEUMOTHORAX, PNEUMOMEDIASTINUM HYPERINFLATION PEAK FLOWS USUALLY 30 TO 50% OF PATIENT’S PERSONAL BEST USE CARE IN PERFORMING PEAK FLOW AS IT MAY WORSEN BRONCHOSPASM FAILURE TO IMPROVE PF AFTER 30 MINUTES OF TREATMENT USUALLY REQUIRES HOSPITALIZATION DIFFERENTIAL DIAGNOSIS CHF PE COPD VOCAL CORD DYSFUNCTION HYPE