Acute Asthma Exacerbation

Question 1

how does an acute asthma attack present?

Answer 1

• dyspnoea
• coughing
• difficulty breathing
• wheeze
• chest tightness

Question 2

what are the features of moderate asthma?

Answer 2

• increasing symptoms
• PEF >50-75%
• no features of severe asthma

Question 3

what are the features of severe asthma?

Answer 3

• PEF 33-50%
• RR >/= 25
• HR >/= 110
• inability to complete sentences

Question 4

what are the features of life-threatening asthma?

Answer 4

33, 92 CHEST
* PEF <33%
* SO2 <92% OR PO2 <8
* cyanosis
* hypotension
* exhaustion
* silent chest
* tachyarrhythmias

normal PCO2 (would expect this group to have low PCO2)

Question 5

what does raised PCO2 indicate during asthma attack?

Answer 5

near fatal episode

Question 6

what is the immediate management of acute asthma attack?

Answer 6

1. sit up
2. 100% O2 via non-rebreathe mask
3. nebulised salbutamol (5mg) + ipratropium (0.5mg)
4. hydrocortisone 100mg iV or prednisolone 50mg PO

Question 7

what is the management of life-threatening asthma?

Answer 7

• inform ICU
• magnesium sulphate 2g IV over 20mins
• nebulised salbutamol every 15mins

Question 8

what are the next steps if initial acute attack management doesnt work?

Answer 8

• nebulised salbutamol every 15mins
• continue ipratropium 0.5mg 4-6 hrly
• consider aminophylline unless already on theophylline
• ITU transfer

Question 9

when is peak flow measured in acute attack?

Answer 9

every 15-30min pre- and post- salbutamol

Question 10

how is acute asthma managed if it has not responded to medical treatment and patient continues to tire?

Answer 10

mechanical ventilation