Asthma

Question 1

What symptoms does asthma present with?

Answer 1

Wheezing, Coughing, Breathlessness

Question 2

What is the respiratory rate of moderate asthma vs acute severe vs life threatening?

Answer 2

Moderate asthma: less than 25bpm
Acute severe: 25 bpm or more
Life-threatening: 25 bpm or more

Question 3

What is the heart rate of Moderate asthma vs
Acute severe vs Life-threatening?

Answer 3

Moderate asthma: less than 110bpm
Acute severe: 110 bpm or more
Life-threatening: Arrhthmia

Question 4

What is the oxygen saturations of Moderate asthma vs Acute severe vs Life-threatening?

Answer 4

Moderate asthma: more than 92%
Acute severe: more than 92%
Life-threatening: less than 92%

Question 5

What is the peak expiratory flow of Moderate asthma vs Acute severe vs Life-threatening?

Answer 5

Moderate asthma: Between 50-70% of best or predicted
Acute severe: Between 33-50% of best or predicted
Life-threatening: Less than 33% of best or predicted

Question 6

What are the other indicators of Moderate asthma vs Acute severe vs Life-threatening?

Answer 6

Moderate asthma: increasing symptoms, Speech normal
Acute severe: Inability to complete full sentences
Life-threatening: Altered consciousness. Cyanosis and Poor respiratory effort.

Question 7

What determines the assessment category of asthma?

Answer 7

Worst feature determines assessment category

Question 8

Which type of asthma patients may be considered for discharge?

Answer 8

Patients whose peak flow is greater than 75% of their best or predicted value one
hour after initial treatment may be considered for discharge

Question 9

When should you call 999?

Answer 9

• Acute severe or life-threatening on
  assessment
• Not improving or worsening after treatment
• If 6 activations of Salbutamol have been
  ineffective
• Patient being treated for hypoxaemia

Question 10

When do you have lower threshold for 999?

Answer 10

• Previous near-fatal asthma
• Previous hospital admission - esp < 12 months
• 3 or more types of asthma drugs
• Heavy use of beta2 agonists
• Repeated A&E visits - esp < 12 months
• Brittle Asthma (rare, unpredictable severe
  attacks)

Question 11

Describe the administration technique for using salbutamol with spacer

Answer 11

• Remove protective caps from mouthpieces of
  the spacer and inhaler.
• Shake canister.
• Insert inhaler mouthpiece into spacer.
• Direct to exhale.
• Apply face mask ensuring seal is effective.
• Compress canister and direct to inhale
  (only introduce 1 metred dose into spacer).
• Direct to hold breath 10 secs if able (if not
  able, keep mask on for 5 breathing cycles).

Question 12

How many activations of salbutamol for moderate asthma?

Answer 12

2 Activations
[8 Activations left]
O2 if SpO2 < 94%

Question 13

How many activations of salbutamol for acute severe asthma?

Answer 13

4 Activations
[6 Activations left]
O2 if SpO2 < 94%
CALL 999

Question 14

How many activations of salbutamol for life threatening asthma?

Answer 14

6 Activations
[4 Activations left]
O2 if SpO2 < 94%
CALL 999

Question 15

If the asthma response to treatment remains same or is getting worse, what do you do?

Answer 15

SALBUTAMOL / SPACER
2 Activations every 2 minutes
[Until 10 in 10-20 minutes]
O2 if SpO2 < 94%
CALL 999 IF 6 ACTIVATIONS FAIL TO MANAGE