Pulmonary Disorders II
Seasonal weather changes
Poor adherence to inhaled corticosteroids
History of near-fatal asthma (e.g., requiring MV)
Active use of oral corticosteroids or completion of recent course for asthma
Not currently using inhaled corticosteroids
Use of more than one canister of short-acting Ξ²-agonists (SABAs) per month
Poor adherence to inhaled corticosteroid containing asthma medications and/or poor adherence to
asthma action plan
History of psychiatric disease or psychosocial problems
Food allergy in a patient with asthma
Social history that includes major psychosocial problems or psychiatric illness
Black and Latinx Americans have higher asthma prevalence and asthma-related morbidity than other
populations.
2 times higher rate of asthma exacerbations compared with those with a household income >=$50,000.
The impacts of long-term stress, health care access, environmental factors, education level, and food
accessibility on disease prevalence and management in patients with asthma are active areas of research.
Patients with well-controlled asthma do not appear to be at increased risk of infection or mortality due
to SARS-CoV-2.
corticosteroids) are at higher risk of hospitalization for severe disease.
Both GINA and the Centers for Disease Control and Prevention recommend that patients receive
vaccination against COVID-19 including boosters if applicable.
If patients are receiving biologics for their severe asthma, it is not recommended to give the first dose
of a biologic agent and the COVID-19 vaccine on the same day.
Alternative Causes (mimic asthma exacerbation) (N Engl J Med. 2023;389(11):1023-1031)
Upper airway: Vocal cord dysfunction, anaphylaxis, laryngeal stenosis
Lower airway: Bronchiolitis, COPD, valvular heart disease, diastolic heart dysfunction
Patients with acute severe asthma initially experience a respiratory alkalosis.
ventilation and/or an increase in physiologic dead space), leading to respiratory acidosis. A Pao2 less
than 60 mm Hg with or without a Paco2 greater than 45 mm Hg may also indicate respiratory failure.
Metabolic (lactic) acidosis may coexist. Lactate production presumably stems from the use of high-dose
Ξ²-agonists, increased work of breathing resulting in anaerobic metabolism of the ventilatory muscles,
and tissue hypoxia.