MKSAP Question: Understand the difference between between dehydration and hypovolemia – dehydration is defined as loss of free water.

Thanks to Fernando for presenting an interesting case!

Teaching Pearls:

• Asthma affects approximately 5% of the population.
• Commonly present in adolescent/young adults, but can also present in the elderly.
• Risk Factors for Asthma Exacerbations: 1) Prior Intubations 2) # of Hospitalizations in Last Year 3) Not on inhaled corticosteroids or PO steroids 4) Tobacco/Polysubstance Abuse 5) Psychosocial Issues 6) Non-compliance 7) Multiple Medical Co-morbidities
• PFTs will demonstrate obstructive airway disease with FEV1/FVC <70%. With bronchodilators, reversibility will be seen.
  • FEV1 improvement of 12% with total change >200cc demonstrates reversibility.
  • TLC will be elevated.
  • DLCO should be normal (Watch out for any false positive and false negative results)
• Antibiotics are not routinely recommended in patients with asthma exacerbation in the absence of a consolidation.
• Beware of a “normal” pCO2 in a patient who is hyperventilating and admitted with asthma exacerbation.
• Treatment of Asthma Exacerbation: Steroids, Short Acting Beta Agonists +/- anticholinergic medications. Needs continual reassessment.