Acute Asthma

Question 1

What is Acute Asthma?

Answer 1

An exacerbation - rapid deterioration in symptoms that can be triggered by any of the typical asthma triggers.

Question 2

Clinical Presentation of MODERATE Acute Asthma (4).

Answer 2

1. PEFR - 50-75% of Predicted.
2. Normal Speech.
3. RR < 25/min.
4. Pulse < 110BPM.

Question 3

Clinical Presentation of SEVERE Acute Asthma (4).

Answer 3

1. PEFR - 33-50% of Predicted.
2. Can’t Complete Symptoms.
3. RR > 25/min.
4. Pulse > 110BPM.

Question 4

Clinical Presentation of LIFE-THREATENING Acute Asthma (5).

Answer 4

1. PEFR - <33% of Predicted.
2. SpO2 < 92%.
3. Silent Chest, Cyanosis, Feeble Respiratory Effort.
4. Bradycardia, Dysrhythmia or Hypotension.
5. Exhaustion, Confusion or Coma.

Question 5

What does a normal pCO2 in an acute asthma attack indicate?

Answer 5

Exhaustion - LIFE-THREATENING.

Question 6

What is ‘Near-Fatal Asthma’ characterised by?

Answer 6

Raised pCO2 and/or requiring mechanical ventilation with raised inflation pressure.

Question 7

Indications of CXR in Acute Asthma.

Answer 7

1. Life-Threatening Asthma.
2. Suspected Pneumothorax.
3. Failure to Respond to Treatment.

Question 8

Indication of ABG in Acute Asthma.

Answer 8

SpO2 < 92%.

Question 9

Indications for Admission in Acute Asthma (6).

Answer 9

1. Life-Threatening Asthma.
2. Severe Asthma Unresponsive to Initial Treatment.
3. Previous Near-Fatal Asthma Attack.
4. Pregnancy.
5. Already on Oral Steroids.
6. Presentation at Night.

Question 10

Medical Management of Acute Asthma (7).

Answer 10

O - SHIT - ME :

1. O - Oxygen (15L via Non-Rebreathe Mask, titrated down to maintain SpO2 between 94-98%).
2. S - SABA (High-Dose via Oxygen-Driven Nebuliser or pMDI).
3. H - Hydrocortisone IV / Oral Prednisolone (5 Days)
4. I - Ipratropium Bromide (SAMA) Nebuliser.
5. Magnesium Sulphate IV.
6. Theophylline / Aminophylline IV.
7. Expert Help.

Question 11

Criteria for Discharge (3).

Answer 11

1. Stable on Discharge Medication for 12-24 Hours.
2. Inhaler Technique is Checked and Recorded.
3. PEFR > 75% of Predicted.

Question 12

Future Management of Asthma (3).

Answer 12

1. Asthma Action Plan.
2. Rescue Pack/Steroids.
3. Referral to Respiratory Medicine after 2 attacks in 12 months.

Question 13

ITU Management of Acute Asthma (2).

Answer 13

1. Intubation and Ventilation.

2. Extracorporal Membrane Oxygenation (ECMO).