Asthma

Question 1

Asthma
Definition

Answer 1

Chronic inflammatory airway disease with recurrent reversible
episodes of bronchospasm and variable airflow obstruction

Question 2

Asthma
Exacerbation Triggers

Answer 2

URTIs
Environmental allergens
Smoking
Exercise

Question 3

Asthma
Classification (CAEP/CTS Asthma Severity):
Respiratory Arrest/Fatal

Answer 3

Appearance: altered mental status, cyanotic, decreased resp. effort
Vitals: low HR, high RR, low O2 sat <90% despite oxygen
Exam: Silent chest – consider preparing for advanced airway intervention

Question 4

Asthma
Classification (CAEP/CTS Asthma Severity):
Severe

Answer 4

Appearance: agitated, diaphoretic, labored respirations, difficulty speaking
Vitals: high HR, high BP, O2 sat 90-95%
Exam: worsening resp. distress, exp/insp. wheezing, FEV1 <40% predicted

Question 5

Asthma
Classification (CAEP/CTS Asthma Severity):
Moderate

Answer 5

Appearance: SOB at rest, cough, congestion, nocturnal symptoms
Vitals: O2 sat >95%
Exam: exp. wheezing, FEV1 40-60% predicted

Question 6

Asthma
Classification (CAEP/CTS Asthma Severity):
Mild

Answer 6

Appearance: SOBOE, chest tightness
Vitals: O2 sat >95%
Exam: exp. wheezing, FEV1 >60% predicted

Question 7

Asthma
Assessment
History

Answer 7

Triggers
Recent infection
Thorough asthma hx including prior
exacerbations, hospitalizations + interventions/ICU stays
Family history

Question 8

Asthma
Assessment
Control Criteria:

Answer 8

Daytime symptoms <4/week
No exercise limitation
No absenteeism
No nocturnal symptoms
Rescue puffer <4/week
Normal PFT
Exacerbations mild/infrequent

Question 9

Asthma
Assessment
Physical Exam

Answer 9

Vitals
Sign of distress
Accessory muscle use
Respiratory exam

Question 10

Asthma
Investigations
Imaging

Answer 10

CXR
ECG

Question 11

Asthma
Investigations
Labs

Answer 11

+/- VBG
Lactate
+/- PEFR (to estimate FEV1)
CBC
CMP, Phos, Magnesium
BCx2
Procalc
CRP
Resp Viral Panel
UA
UC

Question 12

Asthma
Management
Exacerbation

Answer 12

Treat Exacerbation (“0.5 – 5 - 50”)
Ipratropium bromide 0.5mg neb OR 4-8 puffs via MDI + spacer q20mins x 3
Salbutamol 5mg neb OR 4-8 puffs via MDI + spacer q20mins x 3
Prednisone 50mg PO
NOTE: MDIs are superior to nebs unless patient too tachypneic to use MDI

Question 13

Asthma
Management
Sever Asthma

Answer 13

MgSO4 2g IV over 30 mins
Epinephrine 0.3mg IM then 5μg/min IV infusion
Ketamine 1mg/kg (in conjunction with BiPAP)

Question 14

Asthma
Management
Respiratory Failure

Answer 14

Consider NIPPV first (BiPAP)
Intubate (LAST RESORT): Ketamine 1mg/kg IV + Succinylcholine 1.5mg/kgIV
Involve ICU early