asthma Flashcards
what level of acute asthma exacerbation is this?
-PEFR > 50-75% of the patients best or predicted score
-increasing symptoms
-no features of acute severe asthma
moderate acute asthma exacerbation
what type of acute asthma exacerbation is this?
-PEFR 33-50% of the patient’s best or predicted score.
-Respiratory rate (RR) ≥ 25 breaths per minute.
- Heart rate (HR) ≥ 110 beats per minute.
-Inability to complete sentences in one breath.
Severe asthma exacerbation
What type of asthma attack is this?
-PEFR <33% of the patient’s best or predicted score.
-SpO2 <92%.
-Absence of audible breath sounds over the chest (silent chest).
-Cyanosis (usually of the lips).
-Reduced respiratory effort.
-New-onset arrhythmia.
-Exhaustion.
-Reduced Glasgow coma score (GCS).
-Hypotension
life threatening asthma attack
RR>25/ min
pulse >110
Can’t complete full sentences
what type of asthma attack
severe
bradycardia, hypotension, reduced GCS + normal PC02
what type of asthma attack?
life threatening
raised PCO2- type of asthma attack?
near fatal= urgent hospital admission for mechanical ventilation
management of acute asthma attack
OH SHIT ME
Oxygen (15L non rebreather 94-98%)
SABA (salbutamol or terbutaline)
Hydrocortisone IV (or prednisolone)
Ipratropium bromide (SAMA)
Throphylline aminophyilline (get senior)
Magnesium sulphate (IV or neb)
Escalate- call anaesthetist for help (HDU/IT, intubate / ventilate)
investigation done if O2 sats <92?
ABG
1st line investigation for suspected asthma in adults (17 and older)
1st= eosinophil + FeNo
Diagnose + no more investigation if:
-Raised eosinophil
-FeNO 50 or above
Adults (17 and older)
if 1st line investigation comes back negative, but still suspect asthma what investigation next
If not raised= Spirometry + reversible bronchodilator
Diagnose if:
-12% or more increase FEV1 + increase volume 200mls or more
OR
-10% FEV1 raise from predicted FEV1
Adults (17 or older)
if spirometry (2nd line test) is not available but asthma is still suspected what may be done?
Spirometry not available= PEF twice daily for 2 weeks
Diagnose if:
20% variability
5-16 year olds
1st line investigation asthma?
1st- FeNO
Diagnose if 35 or above
5-16 year olds
1st line investigation (FeNO) comes back negative/ isnt available, but asthma still suspected
what is the next test that can be done?
Not raised/ not available= Spirometry + reversible bronchodilator
Diagnose if:
* 12% or more increase FEV1
OR
* 10% FEV1 raise from predicted FEV1
5-16 year olds
Spirometry (2nd line) not available/ negative but there is still a suspicion of asthma
next investigation?
Spirometry not available= PEF twice daily for 2 weeks
Diagnose if:
20% variability
5- 16 year olds
PEF is unavailable/ comes back inconclusive
next line investigation?
Still not diagnosed= skin prick test for house mite dust OR total IgE
If still not diagnosed but in doubt= refer to paeds + bronchial challenge test
investigations for asthma in <5 years?
Clinical diagnosis
asthma management of 12 and older?
Step 1:
-Low dose ICS/ formetarol inhaler (AIR therapy) as required
-if severe symptoms e.g. nocturnal waking= low dose MART therapy (ics + formetarol)
Step 2:
-Low dose MART (ICS + formetarol)
-Preventative (daily) + as required (relieving)
Step 3:
-Moderate dose MART
Step 4:
Check FeNO + blood oesinophil
-Raised= refer to specialist
-not raised= trial LTRA or LAMA with moderate dose MART
Step 5:
-Stop LTRA or LAMA + refer to specialist
<12 years management of asthma
Step 1:
-Low dose ICS/ formetarol (AIR) as required
Step 2:
-Regular low dose MART
Step 3:
-Regular high dose MART
Step 4:
-Refer to specialist
