ACUTE ASTHMA

Question 1

Moderate asthma

Answer 1

• peak flow 50-75%
• able to complete full sentences
• SpO2 > 92%
• Resp rate: <30 (children 5+) <40 (children 1-5)

Question 2

Severe asthma

Answer 2

• Peak flow 33-50%
• Unable to complete full sentences
• Respiratory Rate 25/min or more
• Heart Rates >110bpm

Question 3

Life threatening asthma

Answer 3

• Peak flow < 33%
• Sp02 < 92%
• Cyanosis
• Silent Chest
• Altered consciousness
• Hypotension
• Exhaustion

Question 4

Moderate: treatment

Answer 4

• salbutamol pMDI + spacer up to 10 puffs
• prednisolone 40-50mg for at least 5 days
• patients should be followed up within **48 hours **of discharge or presentation if not admitted

Question 5

Severe/ life threatening: treatment

Answer 5

1. salamol pMDI via spacer/ oxygen-driven nebuliser (life threatening)
   - Consider nebulised ipatropium 500mcg if no response
2. O2 - SpO2 between 94-98%
3. PO CS
   - prednisolone 40-50mg for at least 5 days
   - patients should be followed up within 48 hours of discharge or presentation if not admitted

Question 6

Near-fatal or life-threatening with a poor response to initial therapy

Answer 6

• IV aminophylline
• All patients: Oral prednisolone for 5 days
• If inappropriate: IV hydrocortisone or IM methylprednisolone
• Hypoxaemic patients: Supplementary oxygen (maintain SpO2, between 94-98%)

Question 7

What are the symptoms of moderate acute asthma in children?

Answer 7

1. Able to talk in sentences
2. Arterial oxygen saturation (Sp02) more than or equal to 92%
3. Peak flow equal to or more than 50% predicted
4. HR < 140 (in 2-5yrs) and <125 (Over 5 years old)
5. RR < 40 (2-5yrs) or <30 (Over 5 years old)

Question 8

What are the symptoms of severe acute asthma in children?

Answer 8

1. Cant complete sentences in one breath or is too breathless to talk or feed
2. Sp02 < 92%
3. Peak flow 33-50% of predicted
4. HR > 140 (2-5yrs) OR HR >
   125 (over 5yrs)
5. RR > 40 (2-5yrs) OR RR >30 (over 5yrs)

Question 9

What are the symptoms of life-threatening acute asthma in children?

Answer 9

Symptoms of severe acute asthma AND either one of the
following:
1. Sp02 < 92%
2. Peak flow < 33%
3. Silent chest
4. Cyanosis
5. Poor respiratory effect
6. Hypotension
7. Exhaustion
8. Confusion

Question 10

How do you treat mild-moderate acute asthma attacks in children over 2 years old?

Answer 10

SABA (salbutamol)
PMI and spacer → medical attention if symptoms are not controlled with up to 10 puffs

Question 11

How do you manage severe/life-threatening acute asthma in children over 2 years old?

Answer 11

1. SABA via oxygen driven nebuliser
2. Poor initial response to beta, agonist: add nebulised ipratropium
3. Oxygen
4. PO CS
   - e.g. Prednisolone 1-2mg/kg (Max 40mg) OD for up to 3 days or longer if necessary (e.g. up to 5 days)
   - Advise patients to continue taking ICS

Poor response to first-line treatments:
o IV magnesium sulfate

Question 12

How do you manage acute asthma in under
2 years?

Answer 12

• All children under 2 years → hospital setting
• Moderate and severe: immediate oxygen + trial a SABA
• If needed combine nebulised ipratropium bromide

Oral corticosteroids
- 1-2 mg/kg OD (max. per dose 40 mg) for up to 3 days
- Start early in the
management of severe acute asthma