Acute Asthma Flashcards
What parameters classify moderate asthma in adults?
PEFR 50-70% best or predicted
Normal speech
Resp. rate <25/minute
Heart rate <110 bpm
What parameters classify severe asthma in adults?
PEFR 33-50% best or predicted
Can’t complete sentences
Resp. rate >25/min
Heart rate >110 bpm
What parameters classify life-threatening asthma in adults?
PEFR <33% best or predicted
SpO2 <92%
Signs of exhaustion or hypoxia: silent chest, feeble respiratory effort, hypotension, confusion, cyanosis, coma
What parameters classify near-death asthma in adults?
Raised PCO2
Requiring mechanical ventilation with raise inflation pressures
When do BTS guidelines recommend ABG for assessing asthma in adults?
If SpO2 < 92%
When is a CXR recommended in assessment of asthma in adults?
CXR not routinely recommended, unless:
- life-threatening asthma
- suspected pneumothorax
- failure to respond to treatment
What are the hospital admission criteria for adult patients with acute asthma?
Admission is indicated for the following patients:
- All with life-threatening asthma
- Severe acute asthma who fail to respond to treatment
- Previous near-fatal asthma attack
- Pregnancy
- Attack occurring despite already using oral corticosteroid
- Presentation at night
When is oxygen indicated for acute asthma in adults?
Acutely unwell patients should be started on 15L of supplemental via non-rebreather. This can be titrated down to a flow rate where they are able to maintain SpO2 94-98%.
What is the pharmacological management of asthma in adults?
- Bronchodilation with SABA
- Salbutamol nebuliser (can also be given via metered-dose inhaler if moderate-severe, but in life-threatening always give via oxygen-driven nebuliser) - Corticosteroid
- 40-50mg prednisolone PO daily for minimum 5 days or until recovered from attack
- During this time patients should continue all usual medication, including inhaled corticosteroids - Bronchodilation with SAMA (short-act muscarinic antagonist)
- Ipratropium bromide, nebulised
- Given in life-threatening cases or those not responsive to SABA + corticosteroid - IV magnesium sulphate
- IV aminophylline, consider with senior input
If adult acute asthma fails to respond to all pharmacological treatment, what are the next steps?
Escalate to ICU/HDU setting with senior critical care input
Options include:
- Intubation
- Extracorporeal membrane oxygenation (ECMO)
What are the criteria for discharging an adult patient who presented with acute asthma?
- Stable on discharge meds for 12-24 hours (i.e. no nebulisers or supplementary O2)
- Inhaler technique checked and recorded
- PEF >75% best or predicted
How do you classify the severity of an asthma attack in children aged 2-5 years?
Life-threatening:
- SpO2 <92%
- Silent chest
- Poor respiratory effort
- Agitated, altered consciousness
- Cyanosis
Severe:
- SpO2 <92%
- Too breathless to talk or feed
- Heart rate >140 bpm
- Resp. rate >40/min
- Use of accessory neck muscles
Moderate:
- SpO2 >92%
- No clinical features of severe asthma
How is moderate asthma attack classified in a child older than 5 years?
- SpO2 >92%
- PEF >50% best or predicted
- No clinical features of severe asthma (i.e. able to talk in full sentences, able to feed, resp rate no more than 30/min, heart rate not more than 125 bpm, not using accessory neck muscles)
How is severe asthma attack classified in a child older than 5 years?
- SpO2 <92%
- PEF 33-50% best or predicted
- Unable to complete sentences in one breath or too breathless to talk of feed
- Heart rate >125 bpm
- Resp, rate >30/min
- Use of accessory neck muscles
How is life-threatening asthma attack classified in a child older than 5 years?
- SpO2 <92%
- PEF <33% best or predicted
- Silent chest
- Poor respiratory effort
- Altered consciousness
- Cyanosis
