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      "body": "Great post! Thank you for sharing.",
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      "author": "supremacia3",
      "body": "Thank you",
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      "author": "mavil005",
      "body": "Thanxs op info (👍)",
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      "author": "supremacia3",
      "body": "Definition \nAsthma is a chronic respiratory disease with an inflammatory basis and unknown etiology. In these patients the airway is sensitive to multiple irritant stimuli and is reversible spontaneously or with treatment. It is a disease of high prevalence: 2-6% of the population. Usually with prolonged cough, shortness of breath, wheezing and sensation of chest tightness. \n![62ac0f05603300994fd4f2a69be3a918.jpg](https://steemitimages.com/DQmVggocpfZftUYFxEg2Jp3YkHRXR9wDLsCFnaJVJ3vggPe/62ac0f05603300994fd4f2a69be3a918.jpg)\nDiagnosis \nIt is based on the history of recurrent respiratory symptoms, reversible airway obstruction, especially by spirometry and exclusion of other alternative diagnoses. \nInterrogation \nIn the less than 5 years the diagnosis should be by exclusion of other pathologies that cause wheezing before the impossibility To perform expirometric tests \n![asma.jpeg](https://steemitimages.com/DQmUzePGTybFVdoEN8U8MTMZ1yMAGjijfYptzrMunsGAwuB/asma.jpeg)\nHistory\n\nFamily history of: bronchial asthma. 2. Personal history of: rhinitis or atopic dermatitis diagnosed by the physician. 3. Episodes of wheezing: at least three or more in the last year and more than 24 hours in duration. (Its absence does not exclude the diagnosis). 4. Nighttime symptoms: presence of cough or breathlessness at night that disrupts sleep. Recurrent dyspnea. 6. Recurrent retroexternal pain or pain\nAppearance of symptoms in association with some of the following specific factors\n\n1.Dust or environmental chemicals. 2. Dandruff or animal hair. 3. Time changes. 4. Physical exercise. 5. Homemade octopus. 6. Pollen from plants. 7. Cigarette smoke. 8. Viral infections. 9. Night aggravation of symptoms. 10. Strong Emotional Expressions\nComplementary \nexpirometric tests. High peripheral blood eosinophil counts. Nasal cytology. Test of skin sensitivity to allergens. Rx of the thorax. Others deemed advisable in doubtful cases.\n![neumologo-cadiz-asma.jpg](https://steemitimages.com/DQmY5ju5c5RVfy9Dx5wPBrQLMCL2bgcwiZvD5E5qz2Tmm8N/neumologo-cadiz-asma.jpg)\nDifferential diagnosis of asthma. The family doctor should know the entities with which asthma can be confused and include the following\n\nIn the adult: 1. COPD. 2. Heart failure. 3. Cough secondary to drugs (ACEI). 4. Laryngeal dysfunction. Foreign bodies or tumors of the airway. 6. Pulmonary embolism. 7. Eosinophilic pulmonary infiltration. 8. Dysfunction of the vocal cords.\n\nChildren: High Respiratory Tract 1. Allergic rhinitis. 2. Sinusitis.\n\nAims of treatment - avoid death - restore the patient to the best possible level of activity - maintain optimal respiratory function - prevent relapse through anti-inflammatory treatment\n![c33.jpg](https://steemitimages.com/DQmVcSGHkirMQhZ7EP5kmpz8q5kPoutye56H6JanLk4VxmM/c33.jpg)\n\nTreatment of the asthma crisis in children \nThe treatment of the acute crisis can be staggered according to the intensity of the crisis. In cases of mild crisis, treatment should be performed under the control of the physician and family nurse, either at the office level or at the home level, provided that family members have sufficient training\n\n![hqdefault.jpg](https://steemitimages.com/DQmchsqZXK89Vhhzdo19E7mvrBDW4GicUFUx51kKjRUEj4k/hqdefault.jpg)\n\nInhaled salbutamol treatment (outline). \nSalbutamol inhaled (with spacer and mask in very small children and in infants): 2-4 inh. C / 20 min. During the 1st hour of the mild 4-8 inh crisis. C / 20 min. During the 1st hour in moderate and severe seizures \nSalbutamol in nebulization: 0.01 mg./Kg. (Maximum 5 mg.) 0.5% nebulizer solution Oxygenation of 5 to 6 liters / min should be taken into account.\n\nIf a good response is obtained: - normal respiratory rate, non-dyspnea, PEF> 80%. It is recommended to continue with outpatient treatment: Salbutamol for 3 to 4 hours and restart the usual inter-crisis prophylactic treatment used by the patient. You must attend the doctor's office, 24 hours after the acute crisis, to follow their evolution. \nIf incomplete response is obtained: - normal or increased respiratory rate, moderate dyspnea, mild intercostal impression, PEF 50-80%. A new cycle is recommended with Salbutamol and the early administration of corticosteroids, oral prednisone, 1-2 mg. / Kg. / Day (max 40 mg.) Of 3-7 days. If the answer is incomplete or bad, you should assess your transfer to the hospital emergency department. \nIf a poor response is obtained: - increased respiratory rate (> 60 / min) Major dyspnea, intercostal and suprasternal tracings, nasal flutter, cyanosis, PEF <50%. If you are in the health area (family doctor's office, in the police force), your immediate transfer to a pediatric hospital emergency department should be assessed.\n![Salbutamol_AU_EFG.jpg](https://steemitimages.com/DQmVLf5ZrtGfCChKYEZL9Xh5TGCmQH3UwsxrrGdfQTFdSRY/Salbutamol_AU_EFG.jpg)\n\nThank you very much to all",
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      "author": "supremacia3",
      "body": "Definición\n El asma es una enfermedad respiratoria crónica, con base inflamatoria y de etiología desconocida. En estos pacientes la vía aérea es sensible a múltiples estímulos irritantes y es reversible espontáneamente o con tratamiento. Es una enfermedad de prevalencia elevada: 2-6% de la población. Suele cursar con tos prolongada, disnea, respiración sibilante y sensación de opresión torácica.\n![62ac0f05603300994fd4f2a69be3a918.jpg](https://steemitimages.com/DQmVggocpfZftUYFxEg2Jp3YkHRXR9wDLsCFnaJVJ3vggPe/62ac0f05603300994fd4f2a69be3a918.jpg)\nDiagnóstico\nSe basa en la historia de síntomas respiratorios  recurrentes, obstrucción de la vía aérea reversible, sobre todo por espirometría y exclusión de otros diagnósticos alternativos\nInterrogatorio\nEn el menor de 5 años el diagnostico debe ser por exclusión de otras patologías que provoquen sibilancias ante la imposibilidad de realizar pruebas expirométrica\n![asma.jpeg](https://steemitimages.com/DQmUzePGTybFVdoEN8U8MTMZ1yMAGjijfYptzrMunsGAwuB/asma.jpeg)\nHistoria\n1. La historia familiar de:  asma bronquial. 2. Historia personal de: rinitis  o dermatitis atópica diagnosticadas por el médico. 3. Episodios de sibilancias: al menos tres o más en el último año y de más de 24 horas de duración. (su ausencia no excluye el diagnostico). 4. Síntomas nocturnos: presencia de tos o falta de aire durante la noche que perturban el sueño.5. Disnea recurrente. 6. Expectoración o dolor retroexternal recurrente\n\nAparición de los síntomas en asociación con algunos de los siguientes factores específicos\n\n1. Polvo o químicos ambientales. 2. Caspa o pelos de animales. 3. Cambios de tiempo. 4. Ejercicio físico. 5. Polvo casero. 6. Polen de las plantas. 7. Humo del cigarro. 8. Infecciones virales. 9. Agudización nocturna de los síntomas. 10. Expresiones emocionales fuertes\n\nComplementarios\nPruebas expirométricas. Conteo de eosinófilos en sangre periférica elevados. Citología nasal. Test de sensibilidad cutánea a los alergenos. Rx del tórax. Otros que se estimen convenientes en casos dudosos.\n\n![neumologo-cadiz-asma.jpg](https://steemitimages.com/DQmY5ju5c5RVfy9Dx5wPBrQLMCL2bgcwiZvD5E5qz2Tmm8N/neumologo-cadiz-asma.jpg)\n\nDiagnostico diferencial del asma. El médico de familia debe de conocer las entidades con  que se puede confundir el asma y que comprenden las siguientes\n\nEn el adulto: 1. EPOC. 2. Insuficiencia cardiaca. 3. Tos secundaria a drogas ( IECA). 4. Disfunción laringea. 5. Cuerpos extraños o tumores de la vía aérea. 6. Embolismo pulmonar. 7. Infiltración pulmonar eosinofílica. 8. Disfunción de las cuerdas vocales.\n\nNiños: Vía respiratorias altas 1. Rinitis alérgica. 2. Sinusitis.\n\nObjetivos del tratamiento -  evitar la muerte -  restituir al paciente al mejor nivel de actividad posible -  mantener un función respiratoria óptima -  prevenir la recaída mediante el tratamiento antinflamatorio\n![c33.jpg](https://steemitimages.com/DQmVcSGHkirMQhZ7EP5kmpz8q5kPoutye56H6JanLk4VxmM/c33.jpg)\n\nTratamiento de la crisis de asma en niños\nEl tratamiento de la crisis aguda puede  ser escalonado  de acuerdo a la intensidad de la misma. En casos de crisis ligera,  el tratamiento debe realizarse bajo el control del médico y de la enfermera de la  familia, ya sea a nivel del consultorio  o a nivel del domicilio,  siempre que los familiares tengan suficiente entrenamiento\n\n![hqdefault.jpg](https://steemitimages.com/DQmchsqZXK89Vhhzdo19E7mvrBDW4GicUFUx51kKjRUEj4k/hqdefault.jpg)\n\nTratamiento con Salbutamol inhalado (esquema).\nSalbutamol  inhalado (con cámara espaciadora y con mascarilla en niños muy pequeños y en lactantes): 2-4 inh. c/20 min. durante la 1ra hora de la crisis leve 4-8 inh. c /20 min. durante la 1ra hora en crisis moderadas y graves\nSalbutamol  en nebulización: 0,01 mg./Kg. (máximo 5 mg.) solución nebulizadora al 0,5% Se debe tener presente la oxigenación de 5 a 6 litros / min.\n\n\nSi se obtiene buena respuesta: -  frecuencia respiratoria normal, no disnea, PEF >80%. Se recomienda continuar con tratamiento ambulatorio: Salbutamol por 3 a 4 horas y reiniciar el tratamiento profiláctico intercrisis habitual que utiliza el paciente. Debe asistir al consultorio del médico de familia, a las 24 horas de la crisis aguda, para seguir su evolución.\nSi se obtiene respuesta incompleta: -  frecuencia respiratoria normal o aumentada, disnea moderada, tiraje intercostal leve, PEF 50-80%. Se recomienda nuevo ciclo con Salbutamol y la administración precoz de corticoides, prednisona  oral, 1-2 mg. /Kg. /día (máx. 40 mg.) de 3-7 días. Si la respuesta es incompleta o mala, se deberá valorar su traslado a urgencias del hospital.\nSi se obtiene una mala respuesta: - frecuencia respiratoria aumentada (>60 /min.), disnea importante, tiraje intercostal y supraesternal, aleteo nasal, cianosis, PEF<50%. Si se encuentra en el área de salud (consultorio del médico de familia, en el cuerpo de guardia del policlínico), se debe valorar su traslado inmediato a urgencias de un hospital pediátrico.\n\n![Salbutamol_AU_EFG.jpg](https://steemitimages.com/DQmVLf5ZrtGfCChKYEZL9Xh5TGCmQH3UwsxrrGdfQTFdSRY/Salbutamol_AU_EFG.jpg)\n\nMuchas gracias a todos",
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