Dyspnea, cough, sputum, wheezng (131/1700)

A 20yo student attends the OPD with complaint of breathlessness on and off, cough and sputum.
His sleep is disturbed and skin is very dry in flexural areas of the body. Exam: tachypnea,
hyper-resonant percussion and wheezing on auscultation. What is the most likely dx?

a. Extrinsic allergic alveolitis
b. Asthma
c. Wegener’s granulomatosis
d. COPD
e. Cystic fibrosis


































answer: E
Asthma

Signs and Symptoms

•       dyspnea, wheezing, chest tightness, cough (especially nocturnal), sputum

•       symptoms can be paroxysmal or persistent

•       signs of respiratory distress

•       pulsus paradoxus

•       Spirometry Showing Reversible Airway Obstruction

 FEV1/FVC below lower limit of normal (<0.75 to 0.8 in adults, <0.8-0.9 in children age 6+)

Emergency Management of Asthma

1. inhaled β2-agonist first line (MDI route and spacer device recommended)

2. systemic steroids (PO or IV, if severe)

3. if severe, add anticholinergic therapy ± magnesium sulphate

4. rapid sequence intubation in life-threatening cases (plus 100% O2, monitors, IV access)

5. SC/IV adrenaline if caused by anaphylaxis, IV salbutamol if unresponsive

6. corticosteroid therapy at discharge

Management of Asthma