Acute Asthma and COPD Exacerbation Management

Question 1

What to include in assessment - hx and ix

Answer 1

Hx

1. baseline and severity
2. exacerbation history
3. ICU admissions
4. normal PEFR (if asthmatic)
5. inhaler compliance
6. home oxygen / nebs

PEFR regularly - if asthmatic

Ix

1. ABG - should suggest hyperventilation asthma, if hypoxic or hypercapnia, if patient is tiring
2. CXR - exclude pneumothorax
3. Bloods - including regular potassium monitoring

Question 2

How to classify asthma severity

Answer 2

Life-threatening: PEFR <33% predicted - 33, 92 CHEST

1. 33 - PEFR <33% predicted
2. 92 - SpO2 <92%
3. Cyanosis
4. Hypotension
5. Exhaustion
6. Silent chest
7. Tachycardia

Severe PEFR: <50%

• cannot complete sentences
• resp rate >25
• HR >110

Moderate: PEFR <75%

Mild: PEFR >75%

Question 3

Describe the treatment of an asthma exacerbation

Answer 3

O SHIT ME

Give all together:

• O xygen - use O2 driven nebs
• S albutamol 2.5-5mg NEB
• H ydrocortisone 100mg IV or Prednisolone 40mg PO*
• I pratropium 500mcg NEB

*oral preferred if can swallow (daily), IV (6 hourly)

Give if needed with senior input:

• T hyeophylline: aminophylline infusion (usually in ICU, need daily level, U&Es, cardiac monitor)
• M agnesium sulphate 2g IV over 20 mins (one off dose if poor response/severe/life-threatening, before Theo)
• Escalate care (intubation and ventilation) - if patient tiring, hypoxaemia worsening ANY hypercapnia, involve senior / anaesthetist with view to intubate and ventilate

Question 4

describe the treatment of a COPD exacerbation

Answer 4

O SHIT - as in asthma but

• Prednisolone 30mg PO
• give controlled O2 (24-28% Venturi mask)
• do regular ABGs to determine further O2 therapy

Abx - if any signs of infection

Chest physiotherapy

Consider BiPap in: hypercapnic respiratory acidosis not responding to medical therapy
- or if you can’t deliver enough O2 to maintain sats 88-92% without depressing their respiratory drive and causing a hypercapnic respiratory acidosis

If hypoxia or hypercapnia is worsening despite maximal therapy, involve senior / anaesthetist with a view to intubation and ventilation

Question 5

What are the indications to involve ITU in asthma and COPD exacerbations

Answer 5

1. Requiring ventilator support
2. Worsening hypoxaemia / hypercapnia / acidosis
3. Exhaustion
4. Drowsiness / confusion