Aashi
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A 31-year-old woman presents to the emergency department with three hours of shortness of breath. She had been walking her dog this afternoon and had not been outside for more than a few minutes before she began to feel chest tightness, wheezing, and a cough. She has not had any relief from her bronchodilators or steroid inhalers that she uses daily. She states that her daily activities have become affected by frequent episodes of shortness of breath that recur a few times during each week. These attacks can last days at a time, and she is afraid that her current medications are no longer of assistance to her. On physical examination, she has a temperature of 98.8 F, a pulse of 98/min, a blood pressure of 136/90 mm Hg, and a respiratory rate of 23/min. There is some evidence of hyperemia and secretions in the nasal passages bilaterally. She is using her accessory muscles to breathe, and wheezing is audible. Pulmonary function testing reveals an FEV1 of 68% of predicted, with a reduced FEV1/FVC ratio. This increases by 14% after high-dose bronchodilators are administered. Her peak expiratory flow was 158 L/min before bronchodilators were given. Arterial blood gases on room air are: pH 7.36, pCO2 48 mm Hg, and pO2 60 mm Hg. Chest x-ray shows evidence of hyperinflated lungs. The severity of this patient's clinical condition corresponds with which of the following classifications of asthma?
(A) Moderate intermittent
(B) Severe intermittent
(C) Mild persistent
(D) Moderate persistent
(E) Severe persistent
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| prathapdoctor
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B.severe intermittent.
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| CocaCola
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E - Severe persistant
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| dr.wad
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( B )
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| robin082006
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B
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| Dr.Luck
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b
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| Guptashutosh
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D moderate persistent
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| Aashi
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Answer:
(D) Moderate persistent
Explanation:
This patient presents with an acute attack of asthma, likely precipitated by allergens from the environment. Her symptoms are suggestive of moderate persistent asthma, as she requires the daily use of an inhaled short-acting β2-agonist, the exacerbations are affecting her daily activities, and they recur at a frequency of more than twice per week, lasting days at a time. Other parameters consistent with moderate persistent asthma are the occurrence of nocturnal symptoms more than once per week. Her FEV1 value of 68% is consistent with the criteria for the FEV1 to fall between 60 and 80% of predicted, a reduced ratio of FEV1/FVC to <75%, and the reversibility of airflow obstruction with bronchodilators of greater than 12%. A peak expiratory flow of less than 200 L/min indicates severe airflow obstruction. During a mild asthma exacerbation, arterial blood gases may be normal or reveal a respiratory alkalosis with an increased A-a gradient. The combination of an increased PaCO2 and respiratory acidosis may indicate respiratory failure, and the need for mechanical ventilation should be considered.
There are four classifications of asthma:
1. Mild intermittent -- symptoms less than 2×/week and FEV1 >80%
2. Mild persistent -- symptoms greater than 2×/week but less than l×/day with FEV1 >80%
3. Moderate persistent -- daily symptoms greater than 2×/week with FEV1 >60 and <80%
4. Severe persistent -- continual symptoms with limited physical activity and FEV1 <60%
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
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