[5] Acute Asthma Exacerbation Flashcards
What is an asthma exacerbation?
An acute episode of airflow obstruction occurring on a background of chronic airway inflammation and airway hyper-responsiveness
What initiates an asthma exacerbation?
A trigger
What might trigger an asthma exacerbation?
- Viral or bacterial infection
- Inhaled allergens
- Environmental irritants
- Emotion
- Medication
- Poor adherence to preventative therapy
How does a trigger cause an asthma exacerbation?
It causes bronchoconstriction and increased mucus production, thereby worsening asthma symptoms
What should be noted in the history with each acute asthma attack?
- Duration of symptoms
- Treatment already given
- Course of previous attack
What are the classifications of asthma attacks?
- Moderate
- Severe
- Life threatening
Can the patient talk in a moderate asthma attack?
Yes
What are the oxygen saturations in a moderate asthma attack?
> 92%
What is the peak flow in a moderate asthma attack?
probs over 50% idk this card was wrong before lol cba to look it up
What is the respiratory rate in a moderate asthma attack?
- ≤40 breaths/min in 2-5 years
- ≤30 breaths/min in 5-12 years
- ≤25 breaths/min in 12-18 years
What is the heart rate in a moderate asthma attack?
- ≤140 BPM in 2-5 year
- ≤30 BPM in 5-12 years
- ≤25 BPM in 12-18 years
Can the patient talk in a severe asthma attack?
No, too breathless
What are the oxygen saturations in a severe asthma attack?
<92%
What is the peak flow in a severe asthma attack?
33-50%
What is the respiratory rate in a severe asthma attack?
- > 40 breaths/min in 2-5 years
- > 30 breaths/min in 5-12 years
- > 25 breaths per min
What is the heart rate in a severe asthma attack?
- > 140BPM in 2-5 years
- > 125BPM in 5-12 years
- > 110BPM in 12-18 years
What are the signs of a life threatening asthma attack?
- Silent chest
- Cyanosis
- Exhaustion
- Arrhythmia
- Hypotension
- Altered consciousness
What is the peak flow in a life threatening asthma attack?
> 33%
What are the oxygen saturations in a life threatening asthma attack?
<92%
What are the differential diagnoses for an acute asthma exacerbation?
- Inhaled foreign body
- Viral-induced infantile wheezing
- Aspiration
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
What is the purpose of a CXR when acute asthma is not responding?
Check for pneumothorax and infection
What should be reviewed with the family prior to discharge from hospital after an acute admission?
- When drugs are used (regularly or ‘as required’
- How to use the drug (inhaler technique)
- What each drug does (relief vs prevention)
- How often and how much can be used
- What to do if asthma worsens
- What indicates poorly controlled asthma
What should be done to aid the patient and parents in knowing what to do if asthma worsens?
A personalised written asthma management action plan should be compiled
What things should parents be made aware of that indicate poorly controlled asthma?
- Increasing cough, wheeze, or breathlessness
- Difficult walking, talking, or sleeping
- Decreasing relief from bronchodilators
What can be done in asthmatics who find it difficult to identify a gradual deterioration?
Home measurement of peak flow rate may be helpful
Why is it to important education in the management of asthma?
Outcomes are better for children with a package of educational measures
Has any single component of educational measures in asthma been shown to be beneficial?
No
