Acute Asthma Exacerbation****

Question 1

Brittle asthma - define

Type 1

Type 2

Answer 1

1 - wide variabilityu in PEFR despire intensive therapy

2 - sudden severe attacks despite apparenty well controlled asthma

Question 2

Moderate exacerbation - define

Answer 2

Increasing symptoms

PEFR 50-70%

No features of severe asthma

Question 3

Acute severe exacerbation - define

Answer 3

PEFR 33-50%
RR high
Inability to complete sentences
Use of accessory muscles

Question 4

Near-fatal/life-theatening - define

Answer 4

Resp acidosis
Requiring mechanical ventilation

PEFR <33%
SATS <92%
Silent chest 
Cyanosis 
Feeble resp effort 
Bradycardia 
Dysrhymia 
Hypotension

Question 5

Management for exacerbation

Low SATS
Bronchodilator
Reduces inflammation

1 more med

What should be continued until improvment?

What is they are exhausted, confused/coma?

Answer 5

Sit up - high flow O2

Salbutamol - 5mg O2 nebulized in saline with ipratropium bromide

Hydrocortisone 100mg IV or prednisolone PO
Magnesium sulfate IV - ONE OFF

Aminophylline - give with ondansetron as can cause N&V

Continous nebulizers until improving

CPAP/ITU if worsening

Question 6

What to ensure before discharge

Answer 6

PEFR is above 75 %
Good inhaler technique
Taking inhaled steroids and oral prednisolone
Written management plan

Question 7

Prevention

Answer 7

Reduce triggers
Flu vaccine
Meditterranea diet rich in fruit especially during pregnancy