USMLE/COMLEX - Step 2 - Asthma

Airway obstruction secondary to hyperreactivity in the bronchioles, airway inflammation, mucosal plugging, and smooth muscle hypertrophy. Dry cough Episodic wheezing Dyspnea Chest tightness often worse at night or early morning Decreased breath sounds, Wheezing Prolonged expiration, Increased accessory muscle use Tachycardia Hyperresonance Tachypnea, Hypercapnia, Decreased O2 saturation, Cyanosis Best initial test is spirometry or pulmonary function tests Methacholine challenge test Spirometry/PFTs are best initial test ABG Chest x-ray Acute: albuterol is first line, O2, systemic glucocorticoids Severe: consider intubation Maintenance therapy: 1. Inhaled short-acting beta-agonist such as albuterol 2. Add low-dose inhaled corticosteroid 3. Add long-acting beta-agonist such as salmeterol 4. Medium-dose inhaled corticosteroid and salmeterol (albuterol PRN) 5. High-dose inhaled corticosteroid and salmeterol, or Omalizumab for allergies (albuterol PRN) 6. High-dose inhaled corticosteroid, salmeterol, oral corticosteroid (albuterol PRN) Mnemonic ASTHMA

• Albuterol is first line
• Steroids
• Theophylline
• Humidified oxygen
• Magnesium
• Anticholinergics