Edit concept Question Editor Create issue ticket

Severe Asthma


Presentation

  • Presentation A 15-year-old girl with severe persistent asthma presents to the emergency department with acute respiratory distress. Her common triggers are environmental allergens, predominantly dogs and cats.[pedsinreview.aappublications.org]
  • Methods The definition, diagnosis, and treatment of severe asthma are presented on the basis of a selective literature review and the authors’ clinical experience.[ncbi.nlm.nih.gov]
  • Even though asthma is not always present in AERD, asthma symptoms develop 1–3 years after the development of rhinitis or later.[frontiersin.org]
  • . # IF LIFE-THREATENING FEATURES ARE PRESENT: Discuss with senior clinician and ICU team. Consider IV magnesium sulphate 1.2–2g infusion over 20 minutes (unless already given).[handbook.ggcmedicines.org.uk]
Inflammation
  • You may have increased levels of eosinophils, which can worsen inflammation in your lungs. Inflammation can cause severe asthma attacks.[nucala.com]
  • In addition, ongoing airway inflammation is thought to cause the airway hyperreactivity characteristic of asthma.[en.wikipedia.org]
  • If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed. a Department of Respiratory Paediatrics, Royal Brompton Hospital b Department of Inflammation Repair and[journals.lww.com]
  • ., dendritic cells) to drive type 2 immune responses and stimulate several cell types (including basophils, eosinophils, mast cells, and ILCs) to start and maintain allergic inflammation also in regional draining lymph nodes (e.g., B-cell IgE skewing)[frontiersin.org]
  • Treatment of the bronchial tree from beginning to end: Targeting small airway inflammation in asthma. Allergy. 2013; 68 :16–26. [ PubMed ] [ Google Scholar ] 22. Dias-Junior SA, Reis M, de Carvalho-Pinto RM, Stelmach R, Halpern A, Cukier A.[ncbi.nlm.nih.gov]
Lymphadenopathy
  • Extrinsic compression [ edit ] Airways can be compressed from vascular structures, such as vascular rings, lymphadenopathy, or tumors. Congestive heart failure [ edit ] Airway edema may cause wheezing in CHF.[en.wikipedia.org]
Aspiration
  • Differential diagnoses [ edit ] Allergic bronchopulmonary aspergillosis Aspiration Syndromes Bronchiectasis Bronchiolitis Bronchiolitis obliterans Chronic bronchitis Chronic Obstructive Pulmonary Disease (COPD) Eosinophilic Granulomatosis with Polyangiitis[en.wikipedia.org]
  • Box 3 Diseases that may mimic asthma Congenital or acquired immunodeficiency Primary ciliary dyskinesia Cystic fibrosis (CF) Vocal cord dysfunction (VCD) Central airway obstruction Recurrent aspiration Bronchiolitis Gastroesophageal reflux disease (GERD[ncbi.nlm.nih.gov]
Labored Breathing
Dry Cough
  • Acute severe asthma is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators (inhalers) and corticosteroids. [1] Symptoms include chest tightness, rapidly progressive dyspnea (shortness of breath), dry cough,[en.wikipedia.org]

Workup

Hypercapnia
  • . # Transfer to ICU accompanied by doctor prepared to intubate if: Deteriorating PEF, worsening or persisting hypoxia, or hypercapnia. Exhaustion, altered consciousness Poor respiratory effort or respiratory arrest.[handbook.ggcmedicines.org.uk]

Treatment

  • […] or by oral corticosteroid treatment (for at least six months per year), or is lost when the treatment is reduced.[ncbi.nlm.nih.gov]
  • . # MONITORING : Repeat measurement of PEF 15–30 minutes after starting treatment.[handbook.ggcmedicines.org.uk]
  • Once you have an eosinophilic asthma diagnosis, together, you and your doctor will decide if adding a different kind of asthma treatment could help.[nucala.com]
  • Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking.[journals.lww.com]
  • Acute severe asthma is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators (inhalers) and corticosteroids. [1] Symptoms include chest tightness, rapidly progressive dyspnea (shortness of breath), dry cough,[en.wikipedia.org]

Epidemiology

  • According to a new randomized control trial ketamine and aminophylline are also effective in children with acute asthma who responds poorly to standard therapy. [4] Epidemiology [ edit ] Status asthmaticus is slightly more common in males and is more[en.wikipedia.org]
  • Relationships of active and passive smoking to total IgE in adults of the Epidemiological Study of the Genetics and Environment of Asthma, Bronchial Hyperresponsiveness, and Atopy (EGEA).[frontiersin.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed.[journals.lww.com]
  • Irregularities in the heart beat and abnormal lowering of the blood pressure may be observed. [2] Pathophysiology [ edit ] Inflammation in asthma is characterized by an influx of eosinophils during the early-phase reaction and a mixed cellular infiltrate[en.wikipedia.org]

Prevention

  • Therefore, as AD and the subsequent atopic march mostly present in early infancy, primary, and secondary prevention should be attempted as early as possible to prevent asthma symptoms onset ( 35 ).[frontiersin.org]
  • Azithromycin for prevention of exacerbations in severe asthma (AZISAST): A multicentre randomised double-blind placebo-controlled trial. Thorax. 2013; 68 :322–329. [ PubMed ] [ Google Scholar ] 34. Bousquet J, Aubier M, Sastre J, et al.[ncbi.nlm.nih.gov]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!