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Persistent Physical Symptoms
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
We suggest that just as people with brittle asthma should have easy-to-access care plans, so should people with debilitating physical symptoms, especially where there may be multiple people or agencies involved. We suggest including reception staff in this plan. This may include writing a small script for how to respond to particularly distressing situations or people who contact the clinic very frequently.
Peak expiratory flow
Published in Jonathan Dakin, Mark Mottershaw, Elena Kourteli, Making Sense of Lung Function Tests, 2017
Jonathan Dakin, Mark Mottershaw, Elena Kourteli
Very wide variability in daily PEF readings is a feature of poorly controlled or brittle asthma. Brittle asthmatics may exhibit PEF variability of 40% or more. Large variability in PEF is also observed in the recovery phase of acute severe asthma and indicates ongoing lability. A patient who has been admitted to hospital with acute asthma should not be discharged until the diurnal variability in PEF is less than 25%.
Practice Paper 3: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Propranolol is a non-selective β-blocker that is commonly used to treat hypertension, anxiety, arrhythmia, heart failure and oesophageal varices. β-Blockers inhibit the actions of catecholamines at the β-adrenergic receptors within the heart, producing a negative inotropic and chronotropic effect (i.e. they reduce the force and speed of contraction). They also block peripheral β2-receptors in the vascular smooth muscle and bronchioles, causing peripheral vasodilatation and bronchoconstriction respectively. β-Blockers, especially non-selective agents such as propranolol, are contraindicated in people with asthma, as they may precipitate a life-threatening exacerbation of asthma. As an alternative, selective β1-blockers (e.g. atenolol) have been developed that have minimal affects on the bronchiole β2-receptors and are therefore less likely to cause bronchospasm. They may be safer in asthma compared with non-selective agents, but should still be avoided in patients with severe or brittle asthma.
Pharmacotherapeutic strategies for critical asthma syndrome: a look at the state of the art
Published in Expert Opinion on Pharmacotherapy, 2020
Alessandro Vatrella, Angelantonio Maglio, Corrado Pelaia, Girolamo Pelaia, Carolina Vitale
Different terms have been used to indicate this kind of acute clinical deterioration over the years: near fatal asthma, status asthmaticus, acute severe asthma, brittle asthma, and refractory asthma. The umbrella term ‘Critical Asthma Syndrome’ (CAS) has been proposed to include all these similar but not identical conditions, responsible for acute and life-threatening exacerbations [3].