Acute exacerbations of asthma

Question 1

What is the diagnosis of moderate asthma?

Answer 1

PEFR 50-75%, speaking full sentences

Question 2

What is the diagnosis of severe asthma?

Answer 2

PEFR 33-50%, rep rate >25%, heart rate >110, unable to complete sentences in one breath

Question 3

What is the diagnosis of life-threatening asthma?

Answer 3

PEFR <33%, sats <92%, becoming tired, altered consciousness level, no wheeze, haemodynamic instability (ie shock)

Question 4

How do you initially treat a moderate acute exacerbation of asthma?

Answer 4

B2 agonist bronchodilators, in most cases nebulised β2 agonists given in high doses act quickly to relieve bronchospasm with few side effects.

Question 5

What is the second step in treating a severe acute exacerbation of asthma?

Answer 5

Combining ipratropium bromide with a nebulised B2 agonist to lead to a faster recovery and shorter duration of admission

Question 6

When should you admit patients with severe asthma attacks?

Answer 6

In patients with any feature and it persists after initial bronchodilator treatment.

Question 7

What level should the oxygen sats be maintained in hypoxaemic patients with acute asthma attacks?

Answer 7

> 88-92%

Question 8

What treatment should all patients with severe asthma attacks receive?

Answer 8

steroid therapy

Question 9

When should IV aminophylline be administered

Answer 9

near-fatal asthma or life-threatening asthma with a poor response to initial therapy may gain additional benefit from IV aminophylline.

Question 10

when should antibiotics be administered?

Answer 10

In severe asthma, if there are signs of a bacterial infection

Question 11

What treatment should life-threatening asthma patients receive?

Answer 11

IV magnesium sulphate infusion, intravenous salbutamol, intravenous hydrocortisone, admission to ICU/HDU, intubation in worst cases