Acute Asthma Exacerbation Flashcards
When might children with asthma require hospital admission?
If, after high dose bronchodilator therapy, they;
- Have not responded adequately clinically, i.e. there is persisting breathlessness or tachypnoea
- Are exhausted
- Still have marked reduction in their predicted, or usual best, peak flow rate or FEV1
- Have reduced oxygen saturation (<92% in air)
Psychologically, what is important when managing an asthma attack?
Keep calm and reassure child and parents
What is involved in the management of a moderate asthma attack?
- Short acting ß2 agonist via spacer, with face mask under 3
- Oral prednisolone 1-2mg/kg, maximum 40mg
- Monitor response for 15-30 minutes
What dose of short acting ß2 agonist is given in a moderate asthma attack?
2-4 puffs, increasing by 2 puffs every 2 minutes, up to 10 puffs if required
What is involved in the management of severe asthma?
- Give high flow oxygen
- Short acting ß2 agonist via spacer or nebulised
- Oral prednisolone or IV hydrocortisone
What dose of short acting ß2 agonist is given in severe asthma?
2.5mg salbutamol in <8 years, 5mg in >8 years. Assess response and repeat as required
What additional treatments can be considered in acute severe asthma?
- Inhaled ipratropium or IV ß2-agonist
- Aminophylline
- Magnesium
What is the involved in the management of life-threatening acute asthma?
- High flow oxygen
- Short acting ß2 agonist nebulised
- Oral prednisolone or IV hydrocortisone
- Nebulised ipratropium
What dose of short acting ß2 agonist is given in life-threatening acute asthma?
2.5mg salbutamol in <8 years, 5mg in >8 years. Assess response continuously and repeat as required
What additional therapies can be considered in life-threatening acute asthma?
- IV ß2 agonist
- Aminophylline
- Magnesium
Who should patients with life threatening acute asthma be discussed with?
PICU
What should be done after initial treatment in asthma?
Assess response
What should be done if responding to initial treatment for asthma?
- Continue bronchodilators 1-4 hours prn
- Discharge when stable on 4h treatment
- Continue oral prednisolone for 3-7 days
What should be done if not responding to initial treatment in acute asthma?
- Transfer to HDU/PICU
- Ensure senior medical review
- Consider IV therapies if not already used
- Consider CXR and blood gases
- Consider need for mechanical ventilation
What IV therapies can be considered in acute asthma when the patient is not responding?
- Magnesium
- Aminophylline
- ß2 agonists
