Asthma

Question 1

What is Asthma?

Answer 1

Asthma is a reversible obstructive airway disease usually characterized by chronic inflammation and airway hyperresponsiveness

Question 2

What are the difference severity of acute Asthma?

Answer 2

Mild
Moderate
Severe
Life threatening
Near fatal

Question 3

What are the features of severe asthma attack?

Answer 3

• PEF 33-50%
• Respiratory rate equal to or greater
  than 25
• Pulse greater or equal to 110 beats/min
• Inability to complete sentences in one breath

Question 4

What are the usual doses of Nebulisers and steroids given to a patient in an asthma attack?

Answer 4

Salbutamol 2.5mg QDS and PRN
Ipratropium 500mcg QDS
Prednisolone 40mg OD for 5 days

Question 5

When do we give magnesium in acute asthma attack?

Answer 5

Consider giving a single dose of IV magnesium sulphate (1.2-2g infusion) to patients with:

• Acute severe asthma who have not had a good initial response to inhaled bronchodilator therapy
• Life-threatening or near-fatal asthma

Question 6

When do we give Aminophylline in acute asthma attack?

Answer 6

Consider giving IV aminophylline to patients who do not respond to nebs, steroids, and IV magnesium

Note:
IV aminophylline should only be administered by senior clinician or in a critical care context. It is unlikely to produce additional bronchodilation and is associated with significant side effects (e.g. arrhythmias).

Question 7

When is Intubation required in acute asthma attack?

Answer 7

Patients with asthma who are not responding to treatment, or those with life-threatening asthma/Near fatal asthma, will require urgent critical care input to consider treatment escalation (e.g. intubation and ventilation).

Question 8

When to escalate to your registrar or ITU?

Answer 8

Patients with asthma who are not responding to treatment, or those with life-threatening asthma/Near fatal asthma

Or any asthmatics you are worried about

Question 9

Are there any discharge criteria’s that can help discharge an asthma attack from ED?

Answer 9

• Usually those who have Mild asthma attack (no features of moderate asthma attack) and good support at home can be discharged safely
• Usually need to be nebuliser free and well for 24 hours

Question 10

As per NICE 2024 Asthma guideline, What is a positive FeNO test indicative of asthma (with asthma symptoms)?

A) 25ppb
B) 40ppb
C) 50ppb
D) 60ppb
E) 70ppb

Answer 10

C) 50ppb

Measure the blood eosinophil count or fractional exhaled nitric oxide (FeNO) level in adults with a history suggestive of asthma. Diagnose asthma if the eosinophil count is above the laboratory reference range or the FeNO level is 50 ppb or more. [BTS/NICE/SIGN 2024]