A 62 years old Man Came In With Severe Shortness of Breath Since 2 Day

Before Admission

Yulia Rahmi Z.J*, Elisha Jethro Solaiman*, Eddy M. Salim**

ABSTRACT

1
 affected by cold Moh.Hoesin General prevalence
Hospital
It was weather (+), it was administered to
reported a case with not decreased after ** Staff of Allergy- 1777,496 person
Immunology Division of
shortness of breath at consuming aged 18-45 years
Internal Medicine
RSMH. A 62 years- salbutamol 3x1, the Department of Dr. Moh. living in 70
old man was patient then was Hoesin General Hospital countries2.
admitted with a chief referred to RSMH. INTRODUCTION
complain of The patient
shortness of breath has a history of Asthma is a
since 2 days before asthma since 10 year heterogeneous
admission. One week old and there was not disease, usually
before admitted, medication. The characterized by
patient started to feel patient was also a chronic airway
shortness of breath smoker, since the age inflammation. It is
which was affected of 15 years old defined by the
by cold weather and smoking 1 pack history of respiratory
not reliefed by rest, daily. History of symptoms such as
Wheezing (+), drinking a cup of wheeze, shortness of
nauseous (-), vomit coffee every morning breath, chest
(-), cough (+) with a until now. History of tightness and
clear colored phlegm drinking a cup of tea coughing that vary
(+), fever (-), 4-5x daily. History of over time and in
shivering (-), and drinking alcohol intensity, together
common cold (+) when hes still with variable
sore throat (+). The young. Family expiratory airflow
patient took history of limitation1.
salbutamol and hypertension and The
navacyn and the heart disease from prevalence of asthma
complaint decreased mother, asthma from in younger adults
a little. One day grandmother. Based varies widely as it
before admitted, the on physical does in children. Factors that
patient started to feel examination, quick Overall, 4,3 % of may trigger or
shortness of breath respiratory rate respondents to worsen asthma
which was affected 32xm, the patient WHOs World symptoms include
by cold weather and was wheezing (+) Health Survey aged viral infection,
not relief by rest. with prolonged 18-45 in 2002-2003 domestic or
Wheezing (+), expiration. reported a doctors occuputional
nauseous (-), vomit From the diagnosis of asthma, allergens (e.g. house
(-), cough (+) laboratory findings 4.5 % had reported dust mite, pollens,
phlegm (-), fever (-), Hb: 12,7 mg/dl, that they had cockroach), tobacco
shiver (-). The erythrocyte: experienced attacks smoke, exercise and
patient went to a 4.58x106, leucocyte: of wheezing or stress. These
public health center, 10.500/mm3, whistling breath responses are more
then the patient got hematocrite: 38 %, (symptoms of likely to occur when
salbutamol and the LED: 226, DC : asthma) in the asthma is
compliant little 0/0/93/6, ureum: 31 preceding 12 month. uncontrolled. Some
decreased. Two mg/dL, creatinine: The highest drug can induced or
hours before 0,95 mg/dL, prevalence was trigger asthma, e.g.
admitted, the patient observed in beta-blockers and (in
complained great Keywords : Asthma Australia, Norhern some patient) aspirin
shortness of breath, * Medical Student of and Western Europe or other NSAIDs3.
wheezing (+), Sriwijaya University,
Clerkship Program
and Brazil. The
 Asthma severely reduced spirometry have been admitted, patient
causes symptoms airflow and published 13-15. The started to feel
such as wheezing, ventilation. degree of shortness of breath
However, patients in reversibility in FEV1
shortness of breath, which was affected
this state usually which indicates a
chest tighness and have other physical diagnosis of asthma by cold weather and
cough that vary over signs reflecting the is generally accepted not relief by rest,
time in their exacerbation and its as 12% (or 200 Wheezing (+),
occurence.frequency severity, such as ml) from the pre- nauseous (-), vomit
and intensity. The cyanosis, drowsiness bronchodilator value (-), cough (+)
symptoms are difficulty speaking, 13. However most phlegm (-), fever (-),
tachycardia, asthma patients will
associated with shiver (-), and
hyperinflated chest, not exhibit
variable expiratory use of accessory reversibility at each common cold (+)
air flow, i.e. muscles, and assessment, sore throat (+). The
Difficulty breathing intercostal recession. particularly those on patient got
air out of the lungs Other clinical signs treatment, and the salbutamol and
due to are only likely to be test therefore lacks navacyn and the
bronchoconstriction present if patients are sensitivity. Repeated compliant little
examined during testing at different
(airway narrowing), decreased.
symptomatic periods. visits is advised1.
airway wall Features of Asthma One day
tichkning, and hyperinflation result treatment for adults before admitted,
increased mucus. from patients can be administered patient started to feel
Some variation in breathing at a higher in different ways shortness of breath
airflow can also lung volume in order inhaled, orally or which affected by
occur in people to increase outward parenterally (by cold weather and not
retraction of the subcutaneous,
without asthma, but relief by rest,
airways and maintain intramuscular, or
it is greater in the patency of intravenous Wheezing (+),
asthma. smaller airways injection). The major nauseous (-), vomit
Because (which are narrowed advantage of inhaled (-), cough (+) with
asthma symptoms by a combination of therapy is that drugs colorless phlegm (+),
can vary, the airway smooth are delivered directly fever (-), shiver (-).
physical examination muscle contraction, into the airways, The patient went to
of the respiratory edema, and mucus producing higher
system may be public health center,
hypersecretion). The local concentrations
normal. The most combination of with significantly then the patient got
usual abnormal hyperinflation and less risk of systemic salbutamol and the
physical finding is airflow limitation in side effects1. complaint decreased
wheezing on an asthma a little.
auscultation, a exacerbation Two hours
finding that confirms markedly increases CASE before admitted, the
the presence of the worof breathing1. ILLUSTRATION
airflow limitation. Spirometry patient complained
A 63 years
However, in some is the recommended great shortness of
old man who lives at
people with asthma, method of measuring breath, wheezing (+),
Kenten Laut, Talang
wheezing may be airflow limitation affected by cold
absent or only and reversibility to Kelapa, Banyuasin,
weather (+), it did
detected when the establish a diagnosis Palembang, was
not decreased after
person exhales ofasthma. admitted in
consuming
forcibly, even in the Measurements of Mohammad Hoesin
presence of FEV1 and FVC are salbutamol 3x1, then
General Hospital on
significant airflow undertaken during a patient was referred
the 21th August 2016
limitation. forced expiratory to RSMH.
with chief complaint
Occasionally, in maneuver using a The patient
severe asthma spirometer. of shortness of
has a history of
exacerbations, Recommendations breath since 2 days
asthma since 10
wheezing may be for the before admission.
years old and there
absent owing to standardization of One week before
was not medication. H2O. The chest was hematocrite: 38 breathlessness, chest
The patient denied symmetric both in %,LED: 226 tightness, and
any history of static and dynamic mm/hour, Diff count coughing,
dermatitis, atopy, or breathing. Tactile 0/0/93/6/1, ureum: particularly at night
other allergies. fremitus was 31 mg/dL, or in the early
Patient was also a symmetric upon both creatinine: 0,95 morning. These
smoker, since age 15, lungs, vesicular mg/dL, episodes are usually
smoking 1 pack sound was normal, The patient associated with
daily. History of rales absent and and the family were widespread, but
drinking a cup of wheezing present informed about from variable, airflow
coffee every morning upon both of lungs. the aspect of non- obstruction within
until now. History of For heart pharmacology the lung that is often
drinking a cup of tea examination, ictus patient was bed rest reversible either
4-5 x. History of cordis was neither and avoidance of spontaneously or
drinking alcohol visible nor palpable, inducing factors. The with treatment1.
when hes still upon percussion pharmacology Episodic
young. The patient shows normal result. treatment includes symptoms after an
has a family history On auscultation, D5% gtt xv/minute, incidental allergen
of hypertension and heart sound AI<AII, nebulizer ventolin exposure, seasonal
heart disease from PI<PII, MI>MII, per 8 hours, variability of
mother, asthma from TI>TII normal, no Dexametasone 3x5 symptoms and a
grandmother. murmur and no mg IV, Salbutamol positive family
Based on gallop heard. 3x2 mg, drip history of asthma
the condition of the Inspection on the Aminofilin 36 mg and atopic disease
patient, he was fully abdominal region (1.5 ampule) in D5% are also helpful
conscious, general showed no 500 cc. Differential diagnostic guides.
appearance was abnormalities. In diagnosis of asthma Asthma associated
moderately sick with abdominal is COPD. The with rhinitis may
body weight 45 kg percussion there was patients prognosis is occur intermittently,
and height 160 cm, no shifting dullness. quo ad vitam dubia with the patient
blood pressure On the palpation ad bonam, quo ad being entirely
120/80 mmHg, pulse liver and lien showed fungtionam dubia ad asymptomatic
rate 112x/minute no abnormalities and bonam and duo ad between seasons or it
regular, respiration normal bowel sound sanationam dubia ad may involve seasonal
rate 32x/minute was detected during malam. worsening of asthma
regular and body auscultation. On the symptoms or a
temperature 36.5oC. upper extremities DISCUSSION background of
Physical examination showed no swelling Asthma is a persistent asthma.
of the head, mouth, and lower chronic The patterns of these
ears, throat, showed extremities negative inflammatory symptoms that
no abnormalities, pretibial edema. disorder of the strongly suggest an
eyes upon inspection Based on airways in which asthma diagnosis are
showed no swelling physical many cells and variability;
at his eyelid with examination, high cellular elements precipitation by non-
pale conjungtiva respiration rate play a role. The specific irritants,
palpebra. Physical 32xm, and the chronic such as smoke,
examination of the patient was wheezing inflammation is fumes, strong smells,
neck showed no (+). The laboratory associated with or exercise;
enlargement of findings Hb: 12,7 airway worsening at night;
lymph nodes and mg/dl, erythrocyte: hyperresponsiveness and responding to
jugular venous 4.58x106, leucocyte: that leads to appropriate asthma
pressure (5-2) cm 10.500/mm3, recurrent episodes of therapy.
wheezing,
 The lack of growth factors; and airflow limitation. reversibility in FEV1
a clear definition for determination of the However, in some which indicates a
asthma presents a ratio between Th1 people with asthma, diagnosis of asthma
significant problem and Th2 immune wheezing may be is generally accepted
in studying the role responses (as absent or only as 12% (or 200
of different risk relevant to the detected when the ml) from the pre-
factors in the hygiene hypothesis person exhales bronchodilator value.
development of this of asthma) forcibly, even in the The normal
complex disease, Tobacco presence of range of values is
because the smoking is significant airflow wider and predicted
characteristics that associated with limitation. values are less
define asthma accelerated decline Occasionally, in reliable in young
(e.g.,airway of lung function in severe asthma people (< age 20)
hyperresponsiveness, people with asthma, exacerbations, and in the elderly (>
atopy, and allergic increases asthma wheezing may be age 70). Because
sensitization) are severity, may render absent owing to many lung diseases
themselves products patients less severely reduced may result in
of complex gene- responsive to airflow and reduced FEV1, a
environment treatment with ventilation. useful assessment of
interactions and are inhaled and systemic However, patients in airflow limitation is
therefore both glucocorticosteroids, this state usually the ratio of FEV1 to
features of asthma and reduces the have other physical FVC. The
and risk factors for likelihood of asthma signs reflecting the FEV1/FVC ratio is
the development of being controlle. exacerbation and its normally greater than
the disease. Smoking and severity, such as 0.75 to 0.80, and
Asthma has asthma. Tobacco cyanosis, possibly greater than
a heritable smoking makes drowsiness, 0.90 in children. Any
component, but it is asthma more difficult difficulty speaking, values less than these
not simple. Current to control, results in tachycardia, suggest airflow
data show that more frequent hyperinflated chest, limitation.
multiple genes may exacerbations and use of accessory In this case
becinvolved in the hospital admissions, muscles, and report, patient came
pathogenesis of and produces a more intercostal recession. with shortness of
asthma and different rapid decline in lung Spirometry breath, as known it is
genes may be function and an is the recommended an abnormal
involved in different increased risk of method of measuring breathing or distress
ethnic groups. The death. Asthma airflow limitation symptom. Dyspnea
search for genes patients who smoke and reversibility to could occur due to
linked to the may have a establish a diagnosis various conditions
development of neutrophil- of asthma. such as asthma,
asthma has focused predominant Measurements of COPD, pleura
on four major areas: inflammation in their FEV1 and FVC are effusion, pulmonal
production of airways and are undertaken during a edema, etc. Based on
allergenspecific IgE poorly responsive to forced expiratory the anamnesis,
antibodies (atopy); glucocorticosteroids. maneuver using a shortness of breath in
expression of airway The most spirometer. this patient was not
hyperresponsiveness; usual abnormal Recommendations influenced by
generation of physical finding is for the activity. It was
inflammatory wheezing on standardization of triggered by the
mediators, such as auscultation, a spirometry have been change in weather. In
cytokines, finding that confirms published. The physical findings
chemokines, and the presence of degree of there was no barrel
chest, simetric stem shortness as breath, Uden D.
fremitus, vesicular affected by cold Institute for
sound were normal weather and Clinical
with the presence of smoking, Family Systems
wheezing. Shortness history was asthma Improveme
of breath on this from grandmother, nt. 2012.
patient was caused Wheezing (+) Diagnosis
by asthma. prolonged expiration. and
The Managemen
laboratory findings REFRENCE t of
of these patient were 1. GINA. Asthma :
normal. Differential 2016. Institute for
diagnosis Asthma is Asthma Clinical
COPD. Prognosis Guidlines Systems
quo ad vitam dubia 2016. Improveme
ad bonam, quo ad Tersedia di, nt.
fungtionam dubia ad http:// 4. NHLBI.
malam, quo ad www.ginaas 2014
sanationam dubia ad thma.org. Guidelines
malam. The Diakses for the
management of pada 23 Diagnosis
patient with asthma Agustus and
consists of non- 2016. Managemen
pharmacology and 2. Asher, t of Asthma.
pharmacology. Non Diakses
innes. Et al.
pharmacology is to pada
Global
explain about tanggal 23
Asthma
patients illness to Agustus
Report
the family also 2016.
2014.
including the therapy 5. LJ
Terasedia di
and outcome, bed Akinbami.
www.
rest, and avoidance The state Of
Globalasth
of inducing factors. Chilhood
mareport.or
Pharmacology Asthma,
g. Diakese
therapy for this United State
pada
patient includes D5% , 1980-
tanggal 23
gtt xv/minute, 2005.
Agustus
nebulizer ventolin Advanced
2016.
per 8 hours, Data CDC.
3. Sveum R,
Dexametasone 3x5 2006;381.
Bergstrom
mg IV, Salbutamol Tersedia di,
J, Brottman
3x2 mg, and www.
G, Hanson
aminofilin. Cdc.gov/nh
M, Heiman
M, Johns K, cs/data/ad/a
Malkiewicz d381.pdf.
CONCLUSION Diakses
J, Manney
We have pada
S, Moyer L,
discussed a case of tanggal 23
Myers C,
moderate asthma Agustus
Myers N,
attack in a 63 year 2016.
OBrien M,
old, male patient
Rethwill M,
who also had
Schaefer K,