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 > 25
HR > 110
What feature indicates that a patient with acute severe asthma may have life-threatening asthma?
Normal pCO2
What are the eight clinical features of life threatening acute asthma?
PEFR < 33%
Saturations < 92%
Normal pCO2, Low pH
Poor Respiratory Effort
Silent Chest
Hypotension
Cyanosis
Confusion/Coma
What are the four management options for moderate acute asthma attacks? List it in the stepwise order
Salbutamol Inhalers As Required
Nebulised Ipratropium Bromide
Oral Prednisolone
IV Hydrocortisone
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 feature would result in admission of moderate acute asthma?
A previous near-fatal attack
What are the three management options for severe acute asthma attacks? List it in the stepwise order
Oxygen Therapy
IV Aminophylline
IV Salbutamol
What is the target oxygen saturation level in acute asthma?
94% - 98%
What are the two management options for life threatening acute asthma attacks? List it in the stepwise order
IV magnesium sulphate
We then call an anaesthetist and the intensive care unit, as they may require intubation and ventilation
Once individuals are admitted to hospital with 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 acute asthma attacks, once control has been established?
It is important to utilise a stepwise approach to gradually reduce the administered medications
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 are the three criteria that need to be met before acute asthma patients can be discharged?
PEFR > 75%
Inhaler technique checked and recorded
They should be stable on discharge medications for at least 12 - 24 hours
