Acute Asthma

Question 1

What is the presentation of acute asthma?

Answer 1

• Acute breathlessness
• Wheeze

Question 2

What Hx would you like to seek from pt c acute asthma?

Answer 2

• Recent tx
• previous acute episodes
• best PEFR
• Hx of ICU admission

Question 3

What are the differentials for acute asthma?

Answer 3

• Acute excaerbated COPD
• Pulmonary oedema
• Upper Resp tract obstruction
• PE
• Anaphylaxis

Question 4

What Ix would you order for acute asthma?

Answer 4

• PEFR
• ABG if O2 < 92%
• FBC, U&E
• CXR
  
  • if suspicion of pneumothorax, infection, life threatening attack

Question 5

How would you mx Acute Asthma?

Answer 5

First Line

1. Oxygen

• Aim 94-98%
• If <92% or Life-threatening features

2. Salbutamol

• Nebuliser 2.5-5mg. Repeat every 15-30mins

3. Steroid

• PO Prednisolone 40-50mg daily or
• IV hydrocortisone 100mg 6hrly

4. Ipratropium Bromide

• nebuliser 0.5mg 4-6hrly

Second line

1. Senior clinician review, discuss with HDU/ICU
2. Magnesium Sulfate, B2 agonist, IV aminophylline

Question 6

What do you need to ensure before discharging pt?

Answer 6

• been stable on discharge medication for 24hr
• PEFR >75%
• Check inhaler technique
• at least 5 days oral prednisolone 40-50mg/day if PEFR <50%
• GP appointment within 2days
• Resp clinic within 4weeks

Question 7

What pt education should they receive before discharge?

Answer 7

• Inhaler technique
• Self mx plan
• Peak flow technique
• Adherence
• Trigger avoidance