Acute asthma

Question 1

What three factors cause narrowed airways in asthma?

Answer 1

Bronchial contraction
Increased mucus secretion
Inflammatory mucosal swelling/inflammation

Question 2

What is the presentation of an acute asthma attack?

Answer 2

Dyspnoea and wheeze

Question 3

What are some key aspects to ask in a history in acute asthma attack?

Answer 3

Usual and recent treatment
Previous attack episodes, severity and treatment
Best Peak Flow

Question 4

When is an ABG indicated in acute asthma attack?

Answer 4

If the sats are <92% then pulse oximetry is inaccurate then should use ABG

Question 5

How do you assess the severity of an acute asthma attack?

Answer 5

Severe attack:
-Unable to complete sentences in one breath
-Resp Rate >25/min
-Pulse rate >110bpm
-PEF 33-50% best
Life threatening attack:
-PEF <33% best
-Silent chest, cyanosis, feeble resp effort
-Arrhythmia or hypotension
-Exhaustion or confusion
-ABG sats <92% and normal or high CO2

Question 6

What is the management of an acute severe asthma attack?

Answer 6

Immediately:
-supplemental O2 to maintain 94-98% sats
-Salbutamol 5mg nebulised
-hydrocortisone 100mg IV or prednisolone 40-50mg PO
Reassess every 15 mins:
-If PEF remains below 75% then add ipratropium
-Monitor ECG for arrhythmias
-Consider a single dose of magnesium sulphate IV over 20 mins in those with life threatening features that are not responding to initial treatment

Question 7

If a patient is not improving with acute severe asthma then what should be done??

Answer 7

Should refer to ITU for ventilatory support if any of following are present:

• PEF deteriorating
• Persistent worsening hypoxia
• Hypercapnia
• ABG showing low pH
• exhaustion
• Drowsiness, confusion
• Respiratory arrest

Question 8

If the emergency management of acute asthma attack is improving then what are the next steps?

Answer 8

Continue nebulised salbutamol every 4-6h (+ipratropium)
Prednisolone PO for 5-7 days
Monitor peak flow and o2 sats
If peak flow >75% in 1 hr consider discharge with outpatient follow up

Question 9

How does amiophyline work?

Answer 9

Only used in ICU and inhibits phosphodiesterase

Question 10

What must a patients PEFR improve to for discharge following an attack?

Answer 10

Greater than 75%

Question 11

What 3 questions should be asked at an annual asthma review?

Answer 11

Have you had difficulty sleeping because of astham (Including cough)?
Have you had any asthma symptoms during the day?
Has your asthma interfered with you usual activities e.g. housework?

Question 12

What is the management of chronic asthma in steps?

Answer 12

1 - SABA e.g. salbutamol
2- Add inhaled corticosteroids such as beclamethasone, fluticasone or budesonide titrated to lowest dose - usually 800 micrograms
Only add steroids if SABA being used over 3 times a week
3-Add LABA e.g. salmeterol
4 - specialist input - leukotriene receptor antagonists e.g. montelukast or xanthine derivative such as theophyline