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70: ASTHMA

Angela S. Garcia, PharmD, MPH, CPh; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Extrinsic asthma

  • Intrinsic asthma

  • Exercise-induced asthma

  • Asthmatic bronchitis

  • Bronchial asthma

  • Bronchial hyperresponsiveness

  • Chronic lung disease

ICD-9-CM CODES

  • 493.00 Extrinsic asthma, unspecified

  • 493.01 Extrinsic asthma with status asthmaticus

  • 493.02 Extrinsic asthma with (acute) exacerbation

  • 493.10 Intrinsic asthma, unspecified

  • 493.11 Intrinsic asthma with status asthmaticus

  • 493.12 Intrinsic asthma with (acute) exacerbation

  • 493.20 Chronic obstructive asthma, unspecified

  • 493.21 Chronic obstructive asthma with status asthmaticus

  • 493.22 Chronic obstructive asthma with (acute) exacerbation

  • 493.81 Exercise induced bronchospasm

  • 493.82 Cough variant asthma

  • 493.90 Asthma unspecified type, unspecified

  • 493.91 Asthma unspecified type with status asthmaticus

  • 493.92 Asthma, unspecified type, with (acute) exacerbation

  • 780.7 Malaise and fatigue

  • 786.0 Dyspnea and respiratory abnormalities

  • 786.05 Shortness of breath

ICD-10-CM CODES

  • J44.9 Chronic obstructive pulmonary disease, unspecified

  • J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection

  • J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation

  • J45.20 Mild intermittent asthma, uncomplicated

  • J45.22 Mild intermittent asthma with status asthmaticus

  • J45.21 Mild intermittent asthma with (acute) exacerbation

  • J45.901 Unspecified asthma with (acute) exacerbation

  • J45.902 Unspecified asthma with status asthmaticus

  • J45.909 Unspecified asthma, uncomplicated

  • J45.990 Exercise induced bronchospasm

  • J45.991 Cough variant asthma

  • J45.998 Other asthma

PREFERRED PRACTICE PATTERNS

  • 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders1

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning2

  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction3

  • 6F: Impaired Ventilation and Respiration/Gas Exchange Associated with Respiratory Failure4

FIGURE 70-1

Drug classes useful in obstructive airway disorders include bronchodilators (smooth muscle relaxants) and anti-inflammatory drugs. Bronchodilators include beta2-selective agonists, muscarinic antagonists, and methylxanthines. Anti-inflammatory drugs include mast cell release inhibitors, corticosteroids, and an anti-IgE antibody. Leukotriene antagonists have both bronchodilator and anti-inflammatory mechanisms of action. (From Panus PC, Katzung BG, Jobst EE, Tinsley S, Masters SB, Trevor AJ. Pharmacology for the Physical Therapist. New York, NY: McGraw-Hill; 2009.)

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FIGURE 70-2

Summary of treatment strategies in asthma. (Reproduced with permission from Cockcroft DW. The bronchial late response in the pathogenesis of asthma and its modulation by therapy. Ann Allergy. 1985;55:857.)

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PATIENT PRESENTATION

A 37-year-old nonsmoking man complains of a 3-month history of a nonproductive cough that is worse at night and with exercise. He does not have fevers or other symptoms to suggest infection. He is normotensive, and his lungs are clear to auscultation bilaterally, except for an occasional expiratory wheeze on forced expiration. A chest radiograph is read as normal.5

KEY FEATURES

Description

  • Form of bronchial disorder associated with airway obstruction, marked by recurrent attacks of paroxysmal dyspnea, with wheezing due to spasmodic contraction of the bronchi.6–8

  • Chronic respiratory disease ...

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