So, Josh recently published a guest post on PulmCrit discussing some interesting ideas on the treatment of asthma. This post nearly gave me a stroke. Luckily I had some tPA sitting in my medicine cabinet and just took some empirically, b/c as the stroke neuro folks that respond to Swami's posts tell me, “It can't hurt.”
As soon as I read Josh's post, I knew we must discuss this on the podcast to flesh out some of the issues raised.
You should read the post first:
If you are interested in my Crashing Asthma Cast it is here:
Then you can listen to this EMCrit wee….
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An ED Intensivist from NY. No conflicts of interest (coi).
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Hello,
In today’s time, it’s very rare to find this type of amazing article.
Looking forward to more such articles like this in the near future.
Thank you
I enjoyed this discussion & just have to say you’re both right although it’s not that simple.! Scott, your opinion on the “semi-crashing” asthmatic is only somewhat correct. These type of patients are often exhausted b/c they’ve “trapped” some air in their chest & with that comes increased work of breathing, if it progresses they get to the point where they can’t do it anymore. Try this yourself, take 1/2 vital capacity breath, hold don’t exhale, then continue to vital capacity. Follow this with 3/4 vital capacity breath, hold, then continue to vital capacity. Repeat this sequence 5-10 times & see if how you feel about keeping it going. You’ll appreciate the work of breathing is significant. If you don’t exhale enough, b/c with higher respiratory rate, you will tucker out. As soon as CO2 gets out of range, sympathetic drive increases. The “semi-crashing” asthmatic has to slow down & get a bit of help to overcome their increased work of breathing. They are like you said technically having difficulty inspiring, however they also have “breath stacked” significant auto-peep and can’t expire effectively either. If this vicious cycle continues, they will be “crashing asthmatics”. Respiratory mechanics is very complex, &… Read more »
[…] and Scott Weingart gave a series of engrossing posts and podcasts on asthma. I especially liked their deliberations on mechanical ventilation which inspired me – no pun intended – to create a vodcast of my own […]