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Flashcards in Acute Asthma Deck (12)
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what do they present with in an attack?

acute breathlessness and wheeze


what history may they have?

Ask about usual and recent treatment; previous acute episodes and their severity and best peak expiratory flow rate (PEF). Have they been admitted to ICU?


what should the differential diagnosis be ?

- acute infective exacerbation of COPD

- Pulmonary oedema

- upper respiratory tract obstruction

- pulmonary embolus

- anaphylaxis


what investigations should be done ?

PEF but they may be too ill

- ABG if sats below 92%

- CXR if suspected pneumothorax, infection or life threatening attack


- U and E


what are the features of a severe attack?

Unable to complete sentences
• Respiratory rate >25/min
• Pulse rate >110 beats/min
• Peak expiratory flow 33–50% of predicted or best


what are the features of a life-threatening attack?

Peak expiratory flow 4.6kPa (32mmHg) •
- PaO2


how is an attack treated immediately ?

-Salbutamol 5mg (or terbutaline 10mg) nebulized with O2
-If PEF remains below 75%, repeat salbutamol

-Hydrocortisone 100mg IV or prednisolone 40–50mg PO or both if very ill

- Start O2 if saturations


what must happen for discharge

Been stable on discharge medication for 24h.

• Had inhaler technique checked.

• Peak flow rate >75% predicted or best with diurnal variability


what are the side effects of salbutamol?

tachycardia, arrhythmias, tremor, K+ decreased


why are hydrocortisone and prednisolone given?

they are steroids to reduce inflammation


which factors may require a higher dose?

Smoking, drugs that shorten the half-life, eg
phenytoin, carbamazepine, barbiturates, rifampicin.


what treatment should be given if life threatening features present?

Inform ICU and seniors

• Give salbutamol nebulizers every 15min, or 10mg continuously per hour. Monitor ECG; watch for arrhythmias

• Add in ipratropium 0.5mg to nebulizers

• Give single dose of magnesium sulfate (MgSO4) 1.2–2g IV over 20 mins