Acute asthma

Question 1

Features

Answer 1

-worsening dyspnoea, wheeze and cough that is not responding to salbutamol

-maybe triggered by a respiratory tract infection

Question 2

Moderate

Answer 2

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

Question 3

Severe

Answer 3

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

Question 4

Life threatening

Answer 4

PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
normal PCO2 -indicates exhaustion

Question 5

Near-fatal asthma

Answer 5

raised pC02 and/or requiring mechanical ventilation with raised inflation pressures.

Question 6

Further assessment

Answer 6

-arterial blood gases for patients with oxygen sats < 92%

-chest x-ray is not routinely recommended, unless:

1.life-threatening asthma
2.suspected pneumothorax
3.failure to respond to treatment

Question 7

Mgmt: admission

Answer 7

-all patients with life-threatening
-severe acute asthma if fail to respond to initial treatment
-previous near-fatal asthma attack
-pregnancy
attack occurring despite already using oral corticosteroid
-presentation at night