acute asthma management

Question 1

acute asthma attacks - criteria to determine severity

Answer 1

its either mild-moderate, severe, or life-threatening
SWOMP
speech - full sentence, not full sentence, or very impaired
work of breathing - no increased WOB, increased WOB or looks breathless, poor resp effort
o2 sats - >95%, 90-94%, < 90%
mental state - exhaust, drowsy = severe or higher. collapse = life threat
peripheral cyanosis = severe

Question 2

acute asthma attacks - broadly, what management decisions to consider

Answer 2

BOSMAT
bronchodilators
oxygen
steroids
magnesium sulphate
adrenaline
transfer

Question 3

acute asthma attacks - bronchodilator treatment

• indications
• treatment options
• dosage

Answer 3

all acute asthma needs bronchodilators

mild-moderate
1-5 years old get 2-6 puffs ventolin 100microg
6+ get 4-12 puffs ventolin 100microg

severe
1-5 years old get 6 puffs ventolin 100microg + 4 puffs atrovent 21 microg, repeat every 20 minutes for 3 cycles
6+ get 12/8, rpt every 20 minutes for 3 cycles

if you can’t use a spacer/mask, use nebuliser
ventolin 2x5mg nebs
1-5 atrovent 250microg, 6+ atrovent 500microg

Question 4

acute asthma attacks - magnesium sulphate, when to use and how much

Answer 4

use if poor response
adults - IV, 10mmol, in 100mL n saline, over 20 minutes
kids - IV, 0.1mmol/kg up to 10mmol, in 100mL n saline, over 20 minutes

Question 5

acute asthma attacks - corticosteroids

• when to use
• options

Answer 5

everybody having asthma attacks
prednisolone PO
kids - 1mg/kg up to 50mg PO OD, 3-5 day course
adults - 37.5-50mg PO OD, 5-10 day course

hydrocortisone IV - if you can’t tolerate oral
kids - 4mg/kg up to 100mg, every 6 hours on day 1, 12 hours on day 2, 1 daily on day 3 then re-assess
adults - 100mg every 6 hours

methylprednisolone IV - if you can’t give oral
1mg/kg up to 50mg
6hrly on day 1, 12hrly on day 2, 24hrly on day 3

Question 6

acute asthma attack - adrenaline

• when to use
• how much

Answer 6

if peri arrest, can’t inhale bronchodilators, or unresponsive
IM 1:1000, 0.01mg/kg up to 0.5mg (0.5mL), repeat every 3-5 minutes

Question 7

acute asthma attack

• items to review after 1 hour of bronchodilators
• who should go to hospital

Answer 7

check
dyspnoea when supine
o2 saturation
spirometry

hospital if
FEV1 < 60%
dyspnoea when supine, or at rest despite treatment
still needs bronchodilators

Question 8

acute asthma attack - oxygen

* when to give and how much

Answer 8

in age <= 11, target >95%

in age > 11, target 93-95%

Question 9

acute asthma attack - treatment success at 1 hour

what to review

Answer 9

monitor for additional hour
give prednisolone
modify inhaler doses if needed
review inhaler technique
revise asthma action plan