scholarly journals Severe asthma that was endotracheally intubated 16 times in 20 years

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Luis J Nannini ◽  
Keyword(s):  
Primary Care ◽  
Severe Asthma ◽  
Acute Asthma ◽  
Airflow Obstruction ◽  
Respiratory Muscles ◽  
Airway Disease ◽  
Hyperventilation Syndrome ◽  
Primary Care Site ◽  
Acute Asthma Exacerbation ◽  
Dysfunctional Breathing

Introduction: Severe asthma is a complex airway disease characterised by multiple aggravating-factors, and frequent comorbidities. Poor asthma control does not always correspond to the severity of airflow obstruction. One cause of disproportionate breathlessness in asthma is dysfunctional breathing/hyperventilation syndrome which is increasingly recognized. Case study: This female individual arrived at our asthma centre for the first time, coming from a primary care site 20 years ago. During the past 20 years she was intubated 16 times. Airway obstruction was never assessed surrounding the acute asthma episodes. Asthma diagnosis was confirmed by spirometry many times during routine visits at the asthma centre, where she never came to our asthma centre during an acute asthma exacerbation. Despite warranting the availability of controller medication with high ICS dose plus LABA, she repeated the episodes of severe dyspnoea requiring endotracheal intubations. Results: At a routine outpatient visit to our asthma centre for claiming her asthma medication, she developed an extreme dyspnoea as it occurred so many times earlier, using accessory respiratory muscles. The modified Borg scale for dyspnoea was 9/10. Pulse oximetry showed 96% O2 saturation breathing at room air. Baseline FEV1 was 1.96 L. Dyspnoea did not improve after 30 minutes of treatment. However, the FEV1 increased 29% to 2.53 L (96% predicted). Relaxation respiratory techniques began and the extreme dyspnoea slowly disappeared. Conclusion: Hyperventilation syndrome was confirmed with a score 32 with the Nijmegen Questionnaire (normal <23). Hyperventilation syndrome could coexist with severe asthma in 47% of cases. Keywords: Asthma; Asthma primary care; Hyperventilation syndrome.

scholarly journals Acute exacerbation of asthma: a case report

2011 ◽  
Vol 5 (3) ◽  
pp. 79-85
Author(s):  
Domenico Lorenzo Urso
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Inflammatory Disease ◽  
Asthma Exacerbation ◽  
Acute Asthma ◽  
Airflow Obstruction ◽  
Supplemental Oxygen ◽  
Chronic Inflammatory Disease ◽  
Systemic Corticosteroids ◽  
Acute Asthma Exacerbation

Asthma is a chronic inflammatory disease of the airways with a worldwide prevalence ranging from 1% to 18%. We report the case of a 43-year-old man with acute asthma exacerbation admitted to Emergency Department. All patients with asthma are at risk of having exacerbations characterised by worsening symptoms, airflow obstruction, and an increased requirement for rescue bronchodilators. Patients should be evaluated and triaged quickly to assess the presence of exacerbations and the need for urgent intervention. The goals of treatment may be summarised as maintenance of adequate oxygen saturation with supplemental oxygen, relief of airway obstruction with repetitive administration of rapid-acting inhaled bronchodilators, and treatment of airway inflammation with systemic corticosteroids.

scholarly journals Ventilation heterogeneity in children with severe asthma

2021 ◽  
Author(s):  
Amy G. Nuttall ◽  
Caroline S. Beardsmore ◽  
Erol A. Gaillard
Keyword(s):  
Severe Asthma ◽  
Airway Disease ◽  
Asthma Severity ◽  
Small Airway ◽  
Cross Sectional ◽  
Lung Clearance ◽  
Moderate Asthma ◽  
Lung Clearance Index ◽  
Children With Asthma ◽  
Ventilation Heterogeneity

AbstractSmall airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5–16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV1z-score.Conclusion: VH is present in asthmatic children and appears to be more common in severe asthma. The LCI was significantly higher in the cohort of children with severe asthma, despite no difference in FEV1 between the groups. This supports previous evidence that LCI is a more sensitive marker of airway disease than FEV1. MBNW shows potential as a useful tool to assess children with severe asthma and may help inform clinical decisions. What is Known:• Increased ventilation heterogeneity is present in some children with asthma• Spirometry is not sensitive enough to detect small airway involvement in asthma What is New• Lung clearance index is abnormal in a significant subgroup of children with severe asthma but rarely in children with mild-moderate asthma• Our data suggests that LCI monitoring should be considered in children with severe asthma

scholarly journals Using routinely collected primary care records to identify and investigate severe asthma: a scoping review

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Jonathan Stewart ◽  
Frank Kee ◽  
Nigel Hart
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Severe Asthma ◽  
Scoping Review ◽  
Asthma Severity ◽  
Data Sources ◽  
Full Potential ◽  
High Risk Disease ◽  
Asthma Outcomes ◽  
Disease Variant

AbstractShielding during the coronavirus pandemic has highlighted the potential of routinely collected primary care records to identify patients with ‘high-risk’ conditions, including severe asthma. We aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this ‘high-risk’ disease variant. A scoping review was conducted based on the Arksey and O’Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes could only be investigated through linkage to secondary care records. The ability of primary care records to represent the entire known asthma population is unique. However, a number of challenges need to be overcome if their full potential to accurately identify and investigate severe asthma is to be realised.

scholarly journals Patterns of recovery of airflow obstruction in severe acute asthma

1979 ◽  
Vol 55 (650) ◽  
pp. 877-880 ◽  
Author(s):  
I. S. Petheram ◽  
D. A. Jones ◽  
J. V. Collins
Keyword(s):  
Acute Asthma ◽  
Airflow Obstruction ◽  
Severe Acute Asthma

scholarly journals Risk factors for death in patients with severe asthma

2014 ◽  
Vol 40 (4) ◽  
pp. 364-372 ◽  
Author(s):  
Andréia Guedes Oliva Fernandes ◽  
Carolina Souza-Machado ◽  
Renata Conceição Pereira Coelho ◽  
Priscila Abreu Franco ◽  
Renata Miranda Esquivel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Asthma Control ◽  
Severe Asthma ◽  
Airflow Obstruction ◽  
Care Facility ◽  
Health Care Facility ◽  
Control Program ◽  
Male Gender ◽  
Respiratory Causes

OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.

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