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Respiratory YR3 > Case 1 - Asthma > Flashcards

Case 1 - Asthma Flashcards

1
Q

What are the classifications of asthma attack?

A
  • Mild
  • Moderate
  • Severe
  • Life threatening
  • Near fatal
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2
Q

Mild asthma attack

A

PEFR still >75%
No features of moderate asthma

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3
Q

Moderate asthma attack

A

PEFR between 50-75%
No features of severe asthma

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4
Q

Severe asthma attack

A
  • PEFR 33-50%
  • Cannot speak full sentences
  • HR >110
  • RR >25
  • No features of life threatening attack
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5
Q

Life threatening asthma attack

A
  • PEFR <33%
  • Sats <92% or paO2 <8kpa
  • Normal paCO2
  • Cyanosis
  • Silent chest
  • Altered consciousness
  • Poor respiratory effort
  • Arrhytmia
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6
Q

Near fatal asthma attack

A
  • Raised paCO2
  • Mechanical ventilation with increased inflation pressures
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7
Q

Differentials for asthma attack

A
  • Acute bronchitis
  • PE
  • Pneumonia
  • Cardiac causes?
  • Vocal cord dysfunction
  • GORD
  • Allergy
  • Foreign body
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8
Q

What is controlled O2?

A
  • Avoiding unecessary oxygenation of pt - can sometimes do harm
  • O2 is a drug and should only be given when necessary using target sats eg 94-98% target if non CO2 retainer
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9
Q

What O2 sats do we do ABG?

A

If below 92%

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10
Q

Treatment for asthma attack - just mild/moderate

A
  • 2.5-5mg nebulised Salbutamol
  • 40mg oral prednisolone STAT - 0.5mg/kg (IV hydrocortisone if PO not possible) but no time difference between the two
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11
Q

Added management for asthma attack if pt has severe attack

A
  • Nebulised ipratropium bromide 500 micrograms
  • Back to back nebulised salbutamol - repeat in 15 mins if no improvement
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12
Q

Added management if asthma attack is life threatening/near fatal

A
  • ICU/anaesthetist assessment
  • Urgent portable CXR
  • IV aminophylline?
  • IV salbutamol - unless side effects
  • IV magnesium?
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13
Q

Other causes of raised eosinophils?

A
  • Asthma/COPD - airway inflammation
  • Hayfever/allergy
  • Parasites
  • Allergic bronchopulmonary aspergillosis (fungal hypersensitivity in chronic lung problems)
  • Recurrent abx usage eg in CF
  • Vasculitis
  • Lymphoma
  • SLE
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14
Q

What criteria do pts have to meet to be discharged after asthma attack?

A
  • PEFR >75% best/predicted
  • No nebuliser usage for 24hrs
  • Asthma nurse review inhaler technique and adherance
  • 5 days oral predisolone
  • GP f/u in 2/7
  • Respiratory clinic f/u
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15
Q

What advice should be given to pt following discharge from hospital as an outpatient?

A
  • Confirm diagnosis of asthma as outpatient
  • Avoid triggers - identify using skin prick?
  • Adherance - eg put meds next to toothbrush, alarms etc
  • PEFR and inhaler technique
  • Action plan - self management plan
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16
Q

What is a self management plan for pt following asthma attack?

A
  • Plan for what pt should do if becomes unwell again
  • Can be made using PEFR readings
  • Depending on how severe will either direct to GP or hospital
17
Q

Things that can provoke asthma

A
  • Smoking
  • URTI - viral usually
  • Allergen - eg pollen, dust, pets
  • Exercise - inc cold air
  • Occupation
  • Pollution
  • Drugs - beta blockers, aspirin, eye drops
  • Food and drink - dairy, alcohol, orange juice
  • Stress
  • In severe asthma consider inhaled heroin, psychosocial effects?
18
Q

How common is asthma?

A

1 in 12 adults
1 in 11 children

19
Q

What is asthma?

A
  • Chronic inflammation
  • Reversible - in some pts it isn’t completely
  • Spontaneous reversal or treated
  • Mucus plugging
20
Q

Stepwise management of chronic asthma (BTS guidelines)

A
  • SABA - eg salbutamol
  • ICS
  • LAMA - if no response consider removing LAMA and increasing ICS
  • LTRA, theophylline
  • 4th drug - LTRA, theophylline or B2 agonist tablets
  • Steroid tablets - get specialist advice

Only move to next step if no response to previous - usin salbutamol >3/7

21
Q

Asthma pathophysiology

A
  • Airway epithelial damage - shedding and subepithelial fibrosis, BM thickened
  • Inflammatory reaction - eosinophils, T lymphocytes, mast cells –> histamine, leukotrienes and PGs released
  • Cytokines amplify inflammation response
  • Increased goblet cells, smooth muscle hyperplasia and hypertophy
  • Mucus plugging in fatal and severe
22
Q

Overall acute asthma management

A
  • A-E
  • Aim SpO2 94-98%
  • ABG if sats <92%
  • 5mg nebs salbutamol (can rpt after 15 mins)
  • 40mg oral prednisolone STAT
23
Q
A

Respiratory YR3 (14 decks)

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