Acute Asthma

Question 1

Classifying Asthma Severity

Answer 1

Near Fatal 
Life Threatening 
Severe 
Moderate 
Mild (Brittle)

Question 2

Near Fatal Asthma

Answer 2

RAISED/NORMAL PaCO2 despite hyperventilating

Require mechanical ventilation with raised inflation pressures

Question 3

Life Threatening Asthma

Answer 3

Any one of the following -
33, 92 CHEST

PEFR <33% predicted 
Sats <92% 
Cyanosis 
Hypotension 
Exhaustion 
Silent chest 
Tachycardia/Bradycardia

Question 4

Severe Asthma

Answer 4

ADMIT!

PEFR <50%
Respiratory rate > 25
HR > 110
Inability to complete sentences in one breath

Question 5

Moderate Asthma

Answer 5

PEFR <75%
Increasing symptoms
No features of severe asthma

Question 6

Brittle Type 1 Asthma

Mild (PEFR >75%)

Answer 6

Wide PEF variability despite intense therapy

>40% diurnal variation for > 50% of 150 days

Question 7

Brittle Type 2 Asthma

Mild (PEFR >75%)

Answer 7

Sudden severe attacks on a background of apparently well controlled asthma

Question 8

Acute Asthma History

Answer 8

Baseline and severity
Exacerbations
ICU admissions
Normal PEFR
Infective symptoms
Inhaler compliance
Home O2/nebs?

Question 9

Acute Asthma Investigations

Answer 9

ABG if sats <92%
CXR if indicated
Bloods
Regular K+ monitoring

Question 10

Acute Asthma ABG

Answer 10

Recommended if O2 sats <92%

Question 11

Acute Asthma CXR

Answer 11

Not routinely recommended only:

Life Threatening
Failing to respond to treatment
Suspect pneumothorax

Question 12

Acute Asthma Admit

Answer 12

• Severe not responding to treatment
• Life Threatening
• Pregnant
• Previous non-fatal
• Night presentation
• Attack occurring despite use of oral steroids

Question 13

Acute Asthma Treatment

Answer 13

OSHITME

O2 15L non-rebreather
Salbutamol 2.5-5mg NEB every 10 mins
Hydrocortisone 100mg IV 6 hourly/Prednisolone 50mg oral 5 days
Ipatropium Bromide 500 mcg NEB 6 hourly

Theophylline (Aminophylline 1g in 1L saline)
Magnesium Sulphate 2g IV over 20 mins
Escalate Care

Question 14

Acute Asthma Salbutamol

Answer 14

2.5-5mg IV every 10 minutes

Life threatening = given as nebs with O2

Otherwise = standard pressurised metered dose inhaler

Question 15

Acute Asthma Steroids

Answer 15

Hydrocortisone 100mg IV 6 hourly

or

Prednisolone 40-50mg ORAL daily for at least 5 days after attack

Question 16

Acute Asthma Ipatropium Bromide indications

Answer 16

500 mcg IV every 4-6 hours

Life Threatening
Severe
No response to salbutamol and hydrocortisone/prednisolone

Question 17

Acute Asthma escalation

Answer 17

For intubation/ventilation or Extracorporeal membrane oxygenation (ECMO)

Question 18

Salbutamol side effects

Answer 18

B2 agonist

Tremor
Hypokalaemia
Arrythmias

Question 19

Ipatropium Bromide side effects

Answer 19

Muscarinic antagonist

Arrythmias 
Cough 
Dizzy 
Headache 
Nausea

Question 20

Theophylline side effects

Answer 20

Inhibits phosphodiesterase
Increases cAMP

Palpitations 
Arrythmias
Seizures 
Alkali burns if extravasation occurs 
Nausea

Question 21

Monitoring

Answer 21

Regular Peak Flow 
O2 sats 
ABG 
ECG
Bloods - K+, glucose

Question 22

Discharge criteria

Answer 22

Been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours

Inhaler technique checked and recorded

PEF >75% of best or predicted

Question 23

Follow up

Answer 23

Within 48 hours
Within 30 days with GP/CNS
Under clinical supervision for a year if severe
Under clinical supervision indefinitely if near fatal