Acute asthma Flashcards
What are the symptoms of asthma?
-wheezing
-breathlessness
-chest tightness
-cough
varies over time in their occurence, frequency& intensity
Why are symptoms associated with variable expiratory airflow?
due to:
- Bronchoconstriction
- Airway wall thickening
- Increased mucus
What usually triggers symptoms in asthmatic patients?
- Viral infections
- Allergens
- tobacco smoke
- exercise
- stress
Define acute asthma
- A flare-up or exacerabtion is an acute or sub-acute worsening of symptoms and lung function compared with the patient’s usual status
What is FEV1
- Forced expiratory volume in one second
- amount of air you can blow out in a second
- Best marker of airflow obstruction
- record FEV1 three times and take the highest value
Define peak expiratory flow
- The maximum airflow during a forced expiration beginning with the lungs fully inflated
Describe the characteristics of life-threatening asthma after assessment
- Drowsy
- confused
- silent chest
- Transfer to acute care facility and while waiting: give inhaled SABA and ipatropium bromide, o2, systemic corticosteroid
After the assessment of the patient, when should treatment be started ? What should the treatment entail?
-Even in the case of mild/moderate asthma
The treatment:
-SABA: 4-10puffs by pMDI+ spacer, repeat every 20mins for an hour
-Prednisolone: adults 1mg/kg, max 50mg, children 1-2mg/kg, max 40g
-Controlled oxygen (if available): target saturation 93-95% (children 94-98%)
-Transfer to acute care facility if symptoms worsening
What does acute treatment for acute asthma consist of?
- Repeated high dose inhaled( or nebulised) salbutamol+/- ipratropium
- systemic steroids (oral prednisolone or IV hydrocortisone)
- oxygen if reduced o2 saturations
- IV magnesium as a single dose
what are symptoms of asthma associated with
variable expiratory airflow due to:
- bronchoconstriction
- airway wall thickening
- increased mucus
What can trigger asthmatic symptoms ?
- viral infections(rhinovirus- the common cold is the most frequent trigger)
- tobacco smoke
- exercise
- stress
- allergens
Outline the anatomy of an asthma attack
- Blood vessels infiltrated by immune cells
- Contracted smooth muscle
- Decreased lumen diamater
- Inflammation &swelling
- Increased mucus
How can we improve the spirometry trace of an asthmatic
use a bronchodilator
Outline the possible presentation of a pt with a mild exacerbation of asthma
- Talks in phrases
- Prefers sitting to lying
- Not agitated
- Respiratory rate increased
- Accessory muscles not used
- Pulse rate 100–120 bpm
- O2 saturation (on air) 90–95%
- PEF >50% predicted or best
Outline the possible presentation of a pt with a severe exacerbation of asthma
- Talks in words
- Sits hunched forwards
- Agitated
- Respiratory rate >30/min
- Accessory muscles in use
- Pulse rate >120 bpm
- O2 saturation (on air) <90%
- PEF ≤50% predicted or best
Outline the presentation of a pt with life-threatening asthma
- Drowsy
- Confused
- or silent chest
What treatment would we start with mild/moderate asthma
1.) SABA(4–10 puffs by pMDI + spacer, repeat every 20 minutes for 1 hour)
2.) Prednisolone (adults 1 mg/kg, max.
50 mg, children 1–2 mg/kg, max. 40 mg)
-Controlled oxygen if available (target 93-95% saturation but 94-98% in children)
What treatment would you use for someone with a worsening exacerbation which started off as mild
TRANSFER TO ACUTE CARE FACILITY and While waiting: give inhaled SABA and ipratropium bromide, -O2 -systemic corticosteroid
What does pMDI stand for
pressurised metered dose inhaler
How can we identify patients at risk of asthma-related death?
- Any history of near-fatal asthma requiring intubation and ventilation
- Hospitalization or emergency care for asthma in last 12 months
- Not currently using ICS, or poor adherence with ICS(inhaled corticosteroids)
- Currently using or recently stopped using prednisolone (OCS)
- (indicating the severity of recent events)
- Over-use of SABAs, especially if more than 1 canister/month
- Lack of a written asthma action plan
- History of psychiatric disease or psychosocial problems
- Confirmed food allergy in a patient with asthma
- Flag these patients for more frequent review
What does acute treatment consist of?
- repeated high dose inhaled (or nebulised) salbutamol +/- ipratropium
- systemic steroids (oral prednisolone or IV hydrocortisone)
- Oxygen if reduced O2 saturations
- IV magnesium as a single dose
