Bronchial Asthma 

Essential Disease Information of Bronchial Asthma 

A chronic inflammatory disease of the airways characterized by recurrent episode of cough, wheeze or dyspnea caused by reversible airway obstruction. Airway narrowing results from 

Bronchial muscle constriction, mucosal edema and increased mucus production. 

Important symptoms 

Intermittent cough (especially at night), wheezing, SOB (shortness of breath), may be worse with exercise and cold weather, tightness of chest. 

Important signs 

• Dyspnea 
• Tachycardia  
• tachypnea  

• Unable to lie down 
• Sweating  
• Cyanosis  
• Wheezing or silent chest 
• Retraction of neck muscle 

• Too breathless to speak more than one word ( bad sign)  

Differential Diagnosis  

• Bronchitis 
• Foreign body aspiration  

• Pulmonary edema 
• Anaphylaxis 
• COAD/COPD 
• Tropical eosinophilia 
• P.T.B 

• Pulmonary embolism 
• Pneumothorax 

Screening at risk factors 

• Smoking 

• Atopic disease 
•  Family history  
• Smoky home/ work environment 

Investigaton of Bronchial asthma  

• WBC (whole blood count 
• Chest x-ray 
• AFB sputum if needed 

First aid and emergency management of Bronchial asthma 

• Sit patient upright 
• Check vitals and maintain ABC 
• Check O₂ saturation, administer O_{2 via mask} 
• Remove all tight clothes 

• Record respiratory rate and complete physical examination  
• Do PEER if able 
• Inform duty doctor immediately  
• If severe wheeze or dyspnea inj. Hydrocortisone 100-200 mg iv  
• Assess history thoroughly  

• Repeat salbutamol neb after 15 min if not improving 
• Lab and x-ray investigation as needed 
• Suction if high secretion. 

Treatment of Broncial Asthma: 

• Nebulization with salbutamol in adult: Adult 5mg in 3ml water  
• Nebulization with salbutamol in child: 1.25-2.5 mg in 3ml water  
• Through iv line inj.hydrocortisoe: 100-200 mg in adult 
• And in children 1-2 mg/kg/dose 

• Educate regardign precipitants e.g. stop smoking, smokeless stove use and how to manage their disease, including what to do in an emergency. 

Confirm the diagnosis and continue above management admission if needed with bronchodilator, steroids and O_2.