Acute Asthma

Question 1

What is asthma?

Answer 1

It is a chronic inflammatory airway disease leading to variable airway obstruction

Question 2

What hypersensitivity reaction is associated with asthma?

Answer 2

Type I hypersensitivity reaction

Question 3

What is acute asthma?

Answer 3

It refers to a rapid deterioration in the clinical features of asthma

Question 4

What are the three common triggers of acute asthma?

Answer 4

Infection

Exercise

Cold weather

Question 5

What are the six clinical features associated with acute asthma?

Answer 5

Nocturnal Cough

Dyspnoea

Respiratory Distress Features

Tachypnoea

Expiratory Wheeze

Silent Chest

Question 6

What does a silent chest indicate?

Answer 6

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

Question 7

What are the three classifications of acute asthma?

Answer 7

Moderate

Severe

Life Threatening

Question 8

What are the four clinical features of moderate acute asthma?

Answer 8

PEFR > 50% Predicted

Normal Speech

Normal RR

Normal HR

Question 9

What are the five clinical features of severe acute asthma?

Answer 9

PEFR 33-50% Predicted

Impaired Speech

Respiratory Distress Features

RR > 25

HR > 110

Question 10

What feature indicates that a patient with acute severe asthma may have life-threatening asthma?

Answer 10

Normal pCO2

Question 11

What are the eight clinical features of life threatening acute asthma?

Answer 11

PEFR < 33%

Saturations < 92%

Normal pCO2, Low pH

Poor Respiratory Effort

Silent Chest

Hypotension

Cyanosis

Confusion/Coma

Question 12

What are the four management options for moderate acute asthma attacks? List it in the stepwise order

Answer 12

Salbutamol Inhalers As Required

Nebulised Ipratropium Bromide

Oral Prednisolone

IV Hydrocortisone

Question 13

What drug class does salbutamol belong to?

Answer 13

Beta 2 agonists

Question 14

What are the three side effects of salbutamol?

Answer 14

Tachycardia

Tremor

Hyperkalaemia

Question 15

How does salbutamol cause hyperkalaemia? How do we manage this?

Answer 15

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

Question 16

What drug class does ipratropium bromide belong to?

Answer 16

Anti-muscarinic

Question 17

What feature would result in admission of moderate acute asthma?

Answer 17

A previous near-fatal attack

Question 18

What are the three management options for severe acute asthma attacks? List it in the stepwise order

Answer 18

Oxygen Therapy

IV Aminophylline

IV Salbutamol

Question 19

What is the target oxygen saturation level in acute asthma?

Answer 19

94% - 98%

Question 20

What are the two management options for life threatening acute asthma attacks? List it in the stepwise order

Answer 20

IV magnesium sulphate

We then call an anaesthetist and the intensive care unit, as they may require intubation and ventilation

Question 21

Once individuals are admitted to hospital with acute asthma, how often should they be reviewed? Why?

Answer 21

They are reviewed prior to each next dose their bronchodilator

In order to determine whether their management needs to be stepped up or down

Question 22

How do we manage acute asthma attacks, once control has been established?

Answer 22

It is important to utilise a stepwise approach to gradually reduce the administered medications

Question 23

At what step should acute asthma patients be considered for discharge?

Answer 23

When they are well on a dose of 6 puffs of salbutamol every 4 hrs

Question 24

What are the three criteria that need to be met before acute asthma patients can be discharged?

Answer 24

PEFR > 75%

Inhaler technique checked and recorded

They should be stable on discharge medications for at least 12 - 24 hours