acute asthma summarised

Question 1

where do children under 2 who have acute asthma need to be treated

Answer 1

hospital

Question 2

what is the immediate management of children under 2 with moderate to severe acute asthma

Answer 2

immediate treatment with oxygen via tight fitting face mask or nasal prongs to achieve normal SpO2 of 94-98%

Question 3

what is the immediate treatment of children under 2 with moderate to severe acute asthma - b2 agonist or oxygen?

Answer 3

immediate treatment with oxygen via tight fitting face mask or nasal prongs to achieve normal SpO2 of 94-98%

Question 4

immediate treatment of children under 2 with moderate to severe acute asthma is oxygen via tight fitting face mask or nasal prongs to achieve SpO2 94-98%. what next?

Answer 4

trial inhaled SABA
if response poor, combine nebulised SAMA ipratropium to each nebulised SABA dose

Question 5

in severe asthma attacks in pt under 2, you need to consider the early use of this drug

Answer 5

oral prenisolone daily for up to 3 days

Question 6

what is first line treatment for acute asthma in adults and what should it be given via

Answer 6

high dose inhaled SABA given ASAP

mild to moderate: can be via spacer and pMDI

acute severe or life threatening: recommended via oxygen driven nebuliser

Question 7

1st line acute asthma in adults is high dose inhaled SABA given ASAP. if severe or life threatening symptoms, recommended via oxygen driven nebuliser. if response to initial dose of nebulised SABA is poor, what can you consider

Answer 7

consider continuous nebulised SABA with an appropriate nebuliser

Question 8

Who are IV b2 agonists reserved for in adults

Answer 8

patients in whom inhaled therapy cant be used reliably

Question 9

2 alternatives in patients who are unable to take oral prednisolone

Answer 9

IM methylprednisolone
IV HC

Question 10

When can nebulised ipratropium (SAMA) be combined with nebulised B2 agonist in adults?

(2)

Answer 10

in pt with severe or life threatening acute asthma
or in pt with poor inital response to b2 agonist therapy to provide greater bronchodilation

Question 11

there is some evidence that magesium sulphate has bronchodilator effects. when can a single IV dose of this be considered in adults?

Answer 11

pt with severe acute asthma (PF <50% B/P) who have not had good initial response to inhaled bronchodilator use

Question 12

When can IV aminophylline be used in adults??

Note - in acute asthma it is not likely to produce any additional bronchodilation compared to standard therapy with inhaled bronchodilators and CCs

Answer 12

in some patients with near-fatal or life-threatening acute asthma with a poor response to initial therapy, intravenous aminophylline may provide some benefit

on senior medical staff advice only

Question 13

when should supplementary high flow oxygen be given to children 2 and over

Answer 13

Supplementary high flow oxygen (via a tight-fitting face mask or nasal cannula) should be given to ALL children with life-threatening acute asthma or SpO2 < 94% to achieve normal saturations of 94–98%

Question 14

1st line treatment for acute asthma in children aged 2 and over

Answer 14

inhaled SABA given ASAP

mild to moderate acute asthma: via pMDI and spacer

dose individualised according to severity and adjusted based on response

Question 15

A child’s symptoms of asthma have returned within 3-4 hours. What to do?

Answer 15

urgent medical attention
a further or larger dose (max 10 puffs salbutamol via spacer) should be given whilst awaiting medical condition

Question 16

1st line acute asthma in children 2 and above is inhaled b2 agonist. What if they have had poor inital response to this?

Answer 16

nebulised ipratropium can be combined with nebulised b2 agonist if poor initial response to b2 agonist therapy to provide greater bronchodilation

Question 17

consider adding the following to each nebulised salbutamol and ipratropium bromide in the first hour in children with short duration of severe acute asthma symptoms presenting with oxygen satruation less than 92%

Answer 17

magnesium sulphate

Question 18

what to do if child has continuing severe acute asthma despite frequent nebulised beta2 agonists and ipratropium bromide plus oral corticosteroids, and those with life-threatening features

Answer 18

urgent review by a specialist with a view to transfer to a high dependency unit or paediatric intensive care unit (PICU) to receive second-line intravenous therapies

Question 19

what can be considered as 1st line IV treatment in children who respond POORLY to first line treatments (inhaled bronchodilators)

Answer 19

intravenous magnesium sulfate

Question 20

early addition of the following ….. can be an option in a severe asthma attack where child has not responded to initial inhaled therapy

Answer 20

single bolus dose of intravenous salbutamol

Question 21

when can continuous IV infusion of salbutamol (specialist supervision, continuous ECG and electrolyte monitoring) be considered in children

Answer 21

unreliable inhalation or severe refractory asthma

Question 22

when can IV aminophylline be considered in children

Answer 22

severe or life-threatening acute asthma unresponsive to maximal doses of bronchodilators and corticosteroids