Acute Asthma Flashcards
What is asthma?
It is a chronic inflammatory airway disease leading to variable airway obstruction
What hypersensitivity reaction is associated with asthma?
Type I hypersensitivity reaction
What is acute asthma?
It refers to a rapid deterioration in the clinical features of asthma
What are the three common triggers of acute asthma?
Infection
Exercise
Cold weather
What are the six clinical features associated with acute asthma?
Nocturnal Cough
Dyspnoea
Respiratory Distress Features
Tachypnoea
Expiratory Wheeze
Silent Chest
What does a silent chest indicate?
It is an ominous sign, indicating that the airways have become so tight that there is no movement of air to create a wheeze
It may also be associated with reduced respiratory effort due to fatigue
What are the three classifications of acute asthma?
Moderate
Severe
Life Threatening
What are the four clinical features of moderate acute asthma?
PEFR > 50% Predicted
Normal Speech
Normal RR
Normal HR
What are the five clinical features of severe acute asthma?
PEFR 33-50% Predicted
Impaired Speech
Respiratory Distress Features
RR > 40 (1-5 yrs old), RR > 30 (> 5 yrs old)
HR > 140 (1-5 yrs old), HR > 125 (> 5 yrs old)
What are the seven clinical features of life threatening acute asthma?
PEFR < 33%
Saturations < 92%
Poor Respiratory Effort
Silent Chest
Hypotension
Cyanosis
Confusion/Coma
How do we manage moderate acute asthma attacks?
Salbutamol inhalers via a spacer
What dose of salbutamol inhalers is initially tried in moderate acute asthma attacks?
4-6 puffs every 4 hrs
What are the seven management options for severe acute asthma attacks? List it in the stepwise order
Salbutamol Inhalers
Nebulisers With Salbutamol/Ipratropium Bromide
Oral Prednisolone
IV Hydrocortisone
IV Magnesium Sulphate
IV Salbutamol
IV Aminophylline
What dose of salbutamol inhalers is initially tried in severe acute asthma attacks?
10 puffs every 2 hrs
What drug class does salbutamol belong to?
Beta 2 agonists
What are the three side effects of salbutamol?
Tachycardia
Tremor
Hyperkalaemia
How does salbutamol cause hyperkalaemia? How do we manage this?
It causes cells to absorb increased amounts of potassium from the blood
We conduct monitoring of serum potassium in patients who are administered high doses of salbutamol
What drug class does ipratropium bromide belong to?
Anti-muscarinic
What dose of oral prednisolone is advised in severe acute asthma attacks?
1 mg per kg of body weight once daily for 3 days
Once individuals are admitted to hospital with severe acute asthma, how often should they be reviewed? Why?
They are reviewed prior to each next dose their bronchodilator
In order to determine whether their management needs to be stepped up or down
How do we manage severe acute asthma attacks, once control has been established?
It is important to utilise a stepwise approach to gradually reduce the administered medications
What is a typical step down regime for inhaled salbutamol? (5 steps)
10 puffs every 2 hrs
10 puffs every 4 hrs
6 puffs every 4 hrs
4 puffs every 6 hrs
2 - 4 puffs as required
At what step should acute asthma patients be considered for discharge?
When they are well on a dose of 6 puffs of salbutamol every 4 hrs
What three things should be conducted prior to discharge of acute asthma patients?
They should be prescribed a reducing regime of salbutamol to continue at home
They should be advised to finish their course of steroids, which is usually a 3 day course
They should be given an individualised written asthma action plan
How do we manage life threatening acute asthma attacks?
We need to call an anaesthetist and the intensive care unit
This is due to the fact that they may require intubation and ventilation
