Asthma Flashcards
what are the 3 levels of acute asthma?
moderate, severe, life threatening
what is described as moderate acute asthma? peak flow, speech, SpO2, respiratory rate?
-peak flow >50
-able to complete full sentences
-SpO2 >92%
-respiratory rate < than or equal to 30 (children 5+)
< than or equal to children 1-5
what is described as severe acute asthma? peak flow, speech, SpO2, respiratory rate, heart rate
-peak flow 33-50%
-unable to complete full sentences
-respiratory rate > or equal to 25 (adults), >30 (children 5+), >40 children 1-5
-heart rates >125 bpm children 5+, >140 bpm children 1-5
what is described as life-threatening acute asthma? peak flow, speech, SpO2, respiratory rate?
-peak flow <33%
-Spo2 <92%
-CYANOSIS
-silent chest
-altered consciousness
-hypotension
-exhaustion
what is the management for acute asthma in adults?
-moderate: home or primary care if not go to hospital if not adequate response. treatment high dose SABA via PMI and spacer
-severe or life threatening: hospital immediately. tREATMENT HIGH DOSE SABA (salbutamol 8-10 puffs) via oxygen-driven nebuliser +/-nebulised ipratoprium
-near-fatal or life threatening with a poor reposes to initial therapy: IV amiophylline
what is acute asthma?
like an asthma attack
what is all patients given after an asthma attack?
-all patient: oral prednisolone for 5 days - if inappropriate, IV hydrocortisone or IM methylpredisonsole
what happens if the patients are hyperaemic?
supplementary oxygen (maintain SpO2 between 94-98%)
what is management for acute asthma for children?
2 years and over= severe or life threatening should go hospital immediately (oxygen in life threatening acute asthma or Spo2 <94%)
-first line SABA salbutamol
~mild to moderate: PMI and space medical attention need if symptoms not controlled with up to 10 puffs
Severe or life threatening: via an oxygen-driven nebuliser
what is given to all children fir acute asthma?
3 days oral prednisolone
what is given if there is poor initial response to beta2 agonist?
: add nebulised ipratrioum
what is first line for poor response?
IV MAGNEISUM SULFATE
WHAT IS THE TREATMENT FOR ACUTE ATHMA IN UNDER 2YEARS?
-all children should go to hospital
-moderate and severe: immediate oxygen + trial a SABA
-if needed combine nebulised ipratropium bromide
what are some lifestyle changes for chronic asthma?
-weight loss if overweight
-smoking cessation
breathing exercise programme
what is the treatment for chronic asthma IN ADULTS?
step 1: intermittent reliever (SABA)
STEP 2: SABA + low dose regular preventer (ICS)= start ICS if asthma is uncontrolled with SABA only. (Use SABA 3x a week, symptoms 2 a week, night time awakening at least once a week, using >1 inhaler per month)
Step 3: LTRA (NICE), LABA (BTS/SIGN)= fixed dose or as MART
STEP 4: Add LABA with or without LTRA (nice). Can also add LABA + moderate strength ICS into MART
step 5: INCREASE strength to high strength ics OR INITIATE (SPECIALIST)= THEOPHYLLINE, TIOTRIPIUM, ORAL CORTICOSTERIODS, MONOCOLONICAL ANTIBODIES
what is the low dose of ICS?
beclometasone (clonal)
100mg 2 puffs twice a day
WHAT IS THE TREATEMTN FOR CHRONIC ASTHMA IN CHILDREN over 5?
step 1: intermittent reliever (SABA)
STEP 2: SABA + very low dose regular preventer (ICS)= start ICS if asthma is uncontrolled with SABA only. (Use SABA 3x a week, symptoms 2 a week, night time awakening at least once a week, using >1 inhaler per month)
Step 3: LTRA (NICE), LABA (BTS/SIGN)= IF aged 12+
STEP 4: REPLACE LTRA with LABA if not already on LABA, can be given as MART if not change
STEP 5: increase ICS STRENGTH OR INITATE SPECIALIST: ORAL CORTICOSTERIOD, THEOPHYLLINE, MONOCLONAL ANITIBODIES, TIOTROPIUM (12+)
what strength is the strength of the ICS in children?
clenil 50mcg 2 puffs twice a day
what is the treatment for chronic asthma for children under 5?
step 1: intermittent reliever (SABA), if using more than 1 device per month urgent referral
STEP 2: SABA + regular preventer (ICS) -VERY LOW STRENGTH (paediatric)= start if asthma is uncontrolled with SABA alone and symptoms . use paediatric low dose for an 8 week trial to see if it works before continuing. if ICS not tolerated- an LTRA (montelukast) used instead.
step 3: SABA +ICS+ LTRA. if not controlled stop LTRA and refer to specialist
the. can you drop down from asthma treatment?
-when asthma has been for at least 3 months
-patients should be regularly reviewed when decreasing treatment
-patient should be maintained at the lowest possible dose of ICS, reductions considered every 3 months 25-30% each time
what is complete control?
-no day time symptoms
-no night time awaking
-no asthma atatcks
-no need for rescue medication
-no limitations on activity including exercise
-normal lung function (FEV1 and /or PEF >80% predicted or best
-minimal SE from treatment
