Acute Asthma Exacerbation

Acute Asthma Exacerbation

1. Pathophysiology

   • Allergen
     • IgE production
       • Mast cells degranulation
         • Release of histamine, bradykinies, leukotrienes, prostaglandin, platelet activating factor
           • Vasodilation of capillaries
             • Mucosal edema
           • Bronchoconstriction
           • Mucous secretion
           • Mucosal inflammation
             • Airway obstruction
               • Activation of lung receptors triggering hyperventilation
                 • PaCO2 decrease, pH increases
                   • Respiratory alkalosis
                 • No change in PaCO2
                   • Air trapping increases the pressure and decreases the perfusion in alveoli
                     • Ventilation decreases
                       • PaCO2 increases, pH decreases
                         • Respiratory acidosis

2. Treatment

   • Bronchodilators
   • Oxygen/ Ventilator
   • Steroids
   • Antihistamines

3. Clinical Presentation

   • Chest tightness
   • Coughing
   • Dyspnea
   • Wheezing
   • Respiratory distress

4. Diagnosis

   • Blood work
   • Arterial blood gases
   • Pulmonary function test
   • EKG

5. Risk Factors

   • Young children
   • Smoking
   • Recent viral or bacterial infection
   • Environmental irritants
   • Asthma history
   • Atopic eczema
   • Noncompliance to asthma medication

6. Epidemiology

   • 11 million people have asthma with exacerbation each year in the US
   • 180,000 deaths annually are attributed to asthma worldwide
   • Most asthma deaths occur in ages over 45 years old