Asthma Flashcards
(26 cards)
What is the peak flow of moderate acute asthma
Peak flow >50%
Are moderate acute asthmatic patients able to complete full sentences
Yes
What is the SpO2 in moderate acute asthma
> or equal to 92%
What is the respiratory rate of moderate acute asthma
< or equal to 30 (children 5+)
< or equal to 40 (children 1-5)
What is the peak flow of severe acute asthma
Peak flow 33-50% (Fev)
Are patients who have severe acute asthma able to complete full sentences
No but has spo2 >92%
What is the respiratory rate of severe acute asthma
> or equal to 25 (adult)
30 (children 5-12)
40 (children 1-5)
What is the heart rate of those with sever acute asthma
> 110 BPM ( age 13+)
125 BPM (children 5-12)
140 BPM (children 1-5)
What is the peak flow of those who have life threatening acute asthma
< 33%
What is the SpO2 for those with life threatening acute asthma
< 92%
What are some of the side effects of life threatening acute asthma
Cyanosis
Silent chest
Altered consciousness
Hypotension
Exhaustion
arrhythmia
How do you manage moderate acute asthma in adults
Home or in primary care- hospital if inadequate response
Treatment: high dose SABA (salbutamol) via PMI or spacer
Give 8-10 puffs of salbutamol one after the other until adequate relief in people who have an asthma attack
- MART: 1 puff every 1-3 minutes through spacer (6 puffs max)
Adult- 4 puffs initially, followed by 2 puffs every 2 minutes according to response
Give oral prednisolone in adults 40-50mg for 5 days
Admit to hospital if age under 18, pregnant, previous sever asthma atttack, inadequate treatment response, living alone, pychological problems, pysical or learning disabilities, presentation after mid day
How do you manage severe or life threatening acute asthma
Hospital immediately
Treatment : high dose SABA (salbutamol ) via oxygen-driven nebuliser
5mg to people aged over 5, 2.5mg to children aged 2-5
+/ nebuliser ipratropium if not controlled
Iv magnesium or aminophylline may be also used
Give oral prednisolone
Adults 40-50 for 5 days
Children over 5 30-40 for 3 days
Children 2-5 20 for 3 days
Under 2 10mg for 3 days
I’m methylprednisalone or iv hydrocortisone if can’t have oral prednisolone
How do you manage a near fatal or life threatening with poor response to initial therapy
IV aminophylline
What must all patients have when managing acute asthma in adults
all patients: oral prednisolone for 5 days- if inappropriate: IV hydrocortisone or IM methylprednisolone
In hypoxaemic patients: supplementary oxygen (maintain SpO2 between 94-98%)
What is the acute asthma management for children 2 years and over
Severe or life threatening- hospital immediately (oxygen in life threatening acute asthma or SpO2 <94%)
First line treatment: SABA (salbutamol)
-mid to moderate: PMI and spacer- medical attention if symptoms are not controlled with up to 10 puffs
- sever or life threatening- via an oxygen driven nebuliser
In all cases: 3 days oral prednisolone
Poor initial response to beta2 agonist: add nebulised ipratropium
In response to first line treatments: IV magnesium sulfate
How do you manage acute asthma for children under 2 years old
All children under 2- hospital setting
Moderate and severe: immediate oxygen + trail of SABA
If needed combine nebulised ipratropium bromide
What lifestyle changes would you recommend with someone with chronic asthma
Weight loss in overweight patients
Smoking cessation
Breathing exercise programmes
Identifying and avoiding triggers
Keep warm and dry in cold weather
What is the asthma management plan 12+
Key point: no more SABA without an ICS.
Step 1: low dose inhaled corticosteroid/ formeterol combination when needed
-this combination is called air therapy (budesonide/ formeterol)
- use as MART (maintenance and reliever therapy) in severe cases – step down later.
Step 2: use AIR as maintenance and reliever therapy (MART)
– need reliever 3+ days per week, or having 1+ nights per week of nighttime wakening
- use low dose MART
Step 3: increase maintenance and reliever therapy (MART) dose
– Use moderate dose MART
Step 4: check fractional exhaled nitric oxide (FeNO) level and blood eosinophil count
-if either is raised = referred to a specialist
– if neither is raised at either:
LTRA
LAMA
– gift trail for 8 to 12 weeks unless side effects warrant discontinuation and:
— if controlled equals continue
— if improved by in adequate equals add other medicine (LTRA or LAMA)
— if not improved equals stop LTRA or LAMA and use the other one.
Referred to specialist if still not controlled
Switching patients over from old guidelines (if patient is not controlled) :
– Currently on SABA alone = AIR as needed
-Currently on low dose ICS with SABA/LABA/LTRA = low dose MART
- Currently on moderate dose ICS with SABA/LABA/LTRA = moderate dose MART
- currently on high dose ICS = refer to specialist
When changing low or moderate dose ICS (or ICS/LABA combination inhaler) plus supplementary therapy to MART, consider whether to stop or continue the supplementary therapy based on the degree of benefit achieved when first introduced
What is the low dose for an inhaled corticosteroid for beclametasone
100mg 2 puff BD
Name some inhaled corticosteroid used in asthma
Beclometasone
Budesonide
Ciclesonide
Fluticasone
Mometasone
What is the only LTRA
Montelukast
What is the asthma treatment pathway for children 5-11
Step 1: SABA + paediatric low-dose inhaled corticosteroid (ICS)
- SABA when needed, ICS twice a day
If patient can handle MART therapy
Step 2: switch to formeterol + ICS as maintenance and reliever therapy (MART)
- use paediatric low-dose MART
– increased to paediatric moderate to those MART if not managed
Step 3: switch to ICS/ LABA combination
– twice daily paediatric dose ICS/LABA combination with SABA per when required (+/- LTRA)
- increase ICS dose to paediatric moderate dose if not controlled
What is the treatment pathway for children under 5
Step 1: SABA + paediatric low dose inhaled corticosteroid (ICS)
- SABA when needed, ICS twice a day – 8 to 12 week trial.
—if symptoms do not resolve during trial period:
—Check inhaler technique, adherence, alternative diagnosis, environmental factors.
—If none of these explain failure of treatment = refer to specialist
-if symptoms resolved during trial, consider stopping treatment – review after 3 months
If symptoms of reoccur in 3 months or child has acute episode requiring systemic corticosteroid or hospitalisation
Step 2: restart ICS + SABA
- Start on paediatric low dose and then tighter up to paediatric moderate dose
Step 3: add on a LTRA
-Give 8 to 12 week trial unless there are side-effects.
– stop if ineffective after trial period and refer to specialist
