Asthma

Question 1

Asthma

Answer 1

Chronic long term condition, causes occasional breathing difficulties.

-It affects people of all ages and often starts in childhood,
-it can also develop for the first time in adults.

Managed at home by inhalers :
1. preventer- (steroids, anti -inflammatory) Tilade
2. and reliver ( salbutamol) Ventolin, tiotropium bromide (spiriva) , ipratropium bromide (Atrovent)

Question 2

Asthma Attack

Answer 2

When symptoms get gradually (>6h) temporarily worst:
1. the airways narrow and swell resulting in wheezing and DOB.
2. bronchi become irritated and contract,
3. mucus glands produce excessive sputum which blocks the air passages.

Atopic asthma: after exposed to a trigger such as : -allergies (Dust, animal, pollen),
- smoke, exercise, infection, flu

Question 3

Asthma

Answer 3

can be:

MILD
MODERATE
SEVERE / Life threating
Near fatal

Question 4

Asthma sign and symptoms

Answer 4

-Severe shortness of breath,
-chest tightness or pain,
-coughing or wheezing when exhaling
-Low peak expiratory flow (PEF) readings,

Question 5

Asthma Management

Answer 5

O SHIT:
Oxygen
Salbutamol
Hydrocortisone - steroid , reduce swelling
Ipratropium Bromide
Theophylline- (bronchodilator) not in use due to side effects

Question 6

MILD asthma attacks management

Answer 6

1. • own blue inhaler ( with spacer) as first line treatment
     - increase the dose by two puffs every 2 min and up to 10 puffs.
2. start nebuliser salbutamol

Question 7

SEVERE asthma attacks management

Answer 7

RR>25, HR>110, inability to complete sentence in one breath.
1. Nebulised SALBUTAMOL (6-8l)
2. IPRATROPIUM BROMIDE
3. administer steroids (Hydrocortisone)
4. continuous salbutamol nebulisation

Question 8

Life threating asthma

Answer 8

Altered LOC, exhaustion, arrhythmia, hypotension, cyanosis, silent chest, poor respiratory effort, SpO2 <92

1. Continuous salbutamol nebulisation
2. Adrenaline 1 in 1000 IM only

Question 9

near fatal asthma

Answer 9

Requiring bag-valve mask ventilation using a nebulising T piece
Assess for bilateral tension pneumothorax
1. positive pressure ventilation
2. transfer rapidly, pre alert

Question 10

Ipratropium Bromide (IPR)
(Atrovent) - can be given only once

Answer 10

• Relaxes the muscles around the airways to prevent spasm and stiffness
• Used in treating, symptoms of asthma, colds, allergies, and chronic obstructive pulmonary disease
  -Blocks communication between nerves and muscle cells which normally cause the airways to contract (narrow)
  -Relaxes the airways to stop spasms and stiffness,
  Allows you to breath more easily

-Caution; COPD- limit to 6 minutes f!!!
- if delivered through Oxygen driven nebuliser there is a risk of hypoxic drive; oxygen induced hypercapnia/hypercarbia (elevated carbon dioxide (CO2) levels respiratory acidosis and narcosis).
- Side effects : nausea and vomiting, , dry mouth, tachycardia/arrhythmia. chest tightness, allergic reaction

Question 11

Hydrocortisone
(route: IV, slow injection over 2 minutes,
or IM)

Answer 11

• Reduces inflammation and suppress the immune response.

Pre-hospital use;
Severe Asthma,
Anaphylaxis,
Adrenal crisis ( Addison crisis)
Croup.
Other uses: LRTI, Pneumonia, COPD,

Side effects: sodium phosphate may cause burning or itching sensation to the groin if administer too quickly.

Question 12

Salbutamol - side effects and doses

Answer 12

• Tremor (shaking)
• tachycardia
• Palpitation
• Headache
• Feeling of tension
  -Peripheral vasodilatation
  -muscle cramps
  -rash

DOSES:
-with O2 running at 6-8 l,
-repeated doses at an interval of 5 minutes between doses
- 7y/o and above : 5mg
- one month to 6 years : 2.5 mg
- if COPD - limit to 6 minutes if using oxygen