Respiratory Series: Case 1


A 13 year old boy comes to hospital, short of breath and describes tightness over the precordium. His symptoms started when she was doing physical education at school.
Upon auscultation of his lung fields, you note loud biphasic wheezing and decreased air entry.

Image result for asthma

1. What are you suspecting this patient has ?

2. What are the risk factors for developing this condition ?

3. How would you investigate further ?

4. Describe the standard guide for achieving control of this condition.

5. Six months later, the patient suffers an acute exacerbation of his asthmatic symptoms. How would you manage in this case ?

6. Describe primary and secondary prevention options that the doctor should explain to the patient.



1. Bronchial Asthma


Image result for risk factors for bronchial asthma

3. Investigations

  • Pulse Oximetry and ABG analysis
  • Chest X-ray
  • Peak Flow meter and Spirometry
  • Skin Testing

4. Steps for Management of Asthma to achieve control

Image result for treatment for achieving control asthma

5. Management of Acute exacerbation

Aim: relieve airway obstruction and hypoxaemia as quickly as possible, plan to prevent future exacerbation.

  • Oxygen inhalation 4L/min to maintain SpO2 above 90%
  • Terbutaline IV 10mcg/kg or Adrenaline IV 1:1000 0.01ml/kg every 20-30 minutes, up to three times
  • Inhaled Salbutamol by nebuliser with spacer +/- facemask
    1-2 puffs every 2-4 mins up to 10 puffs, repeat every 20-30 mins
  • Ipratropium bromide via nebulizer
  • Hydrocortisone IV
  • Aminophylline IV slow infusion
  • Magnesium Sulphate IV in 50ml 5% dextrose slow infusion over 30mins

6. Prevention





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