Acute Asthma

Question 1

Moderate attack

Answer 1

SpO2 > 92%
No clinical features of severe asthma
PEF > 50% best or predicted

Question 2

Severe

Answer 2

SpO2 < 92%
PEF 33-50% best or predicted
Too breathless to talk or feed
Heart rate
>125 (>5 years)
>140 (1-5 years)
Respiratory rate 
>30 breaths/min (>5 years)
>40 (1-5 years)
Use of accessory neck muscles

Question 3

Life Threatening

Answer 3

SpO2 <92%
PEF < 33% best or 
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis

Question 4

If not responding back to back salbutamol

Answer 4

Add Ipratropium bromide

magnesium sulphate recommended as next step for patients who are not responding (e.g. 1.2 - 2g IV over 20 mins)

little evidence to support use of IV aminophylline (although still mentioned in management plans)

if no response consider IV salbutamol

Question 5

Mx of mild to moderate asthma

Answer 5

Bronchodilator therapy
give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)

give 1 puff every 15-30 seconds up to a maximum of 10 puffs; repeat dose after 10-20 minutes if necessary
if symptoms are not controlled repeat beta-2 agonist and refer to hospital

Steroid therapy
should be given to all children with an asthma exacerbation
treatment should be given for 3-5 days