asthma Flashcards
acute asthma classification
moderate
peak flow > 50%
normal speech
severe
peak flow 33-50%
unable to complete full sentences
spo2 > 92%
resp rate:
> 25 (13+)
> 30 (children 5-12)
>40 (children 1-5)
heart rate
> 110 (13+)
>125 (children 5-12)
>140 (children 1-5)
life-threatening
peak flow < 33%
spo2 < 92%
altered consciousness
cardiac arrhythmias
hypotension
cyanosis
silent chest
exhaustion
moderate acute asthma management
usually can be done in community
require hospitalisation if <18, pregnant, previous severe asthma attack, inadequate treatment response, living alone, psychological problems, physical/learning disabilities or presentation after midday
use a SABA through large volume spacer - upto 10 puffs
adults - 4 puffs initially, followed by 2 puffs every 2 mins according to response
children - 1 puff every 30-60 seconds - upto 10 puffs
give oral pred 40-50mg OD 5 days in ADULTS
severe or life-threatening acute asthma management
high dose salbutamol via oxygen driven nebuliser:
- 5mg for people > 5
- 2.5mg in children 2-5
- add nebulised ipratropium if not controlled
- IV magnesium or aminophylline
oral prednisolone:
- 40-50mg OD 5 days in adults
- 30-40mg OD 3 days in children >5
- 20mg OD 3 days in children 2-5
- 10mg OD 3 days in children <2
IM methylpred or IV hydrocort if oral pred not available
lifestyle changes for chronic asthma
weight loss in overweight pts
smoking cessation
breathing exercise programmes
identifying and avoiding triggers
keep warm and dry in cold weather
chronic asthma treatment in >12
key point - no more SABA without ICS
step 1 - low dose ICS/formoterol combination PRN
- AIR therapy budesonide/formoterol (symbicort)
- use as MART in severe cases - step down when controlled
step 2 - use AIR as MART
- need reliever 3+ days per week or 1+ night a week of night time waking
- low dose MART
step 3 - increase MART dose
- moderate-dose MART
step 4 - check fractional exhaled nitric oxide (FENO) and blood eisinophil levels
- if either raised - refer to specialist
- if neither raised - add LTRA or LAMA
trial 8-12 weeks
- if controlled - continue
- if improved but inadequate - add other one (LTRA/LAMA)
- if not improved - stop LTRA or LAMA and add other one
refer to specialist if still not controlled
what are the switches from old guidelines
only switch if not controlled from old guidelines
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
high dose ICS - refer to specialist
chronic asthma treatment in 5-11
step 1 - SABA + paediatric low dose ICS
- SABA when needed
- ICS BD
step 2 - switch to formoterol + ICS as MART
- paediatric low dose MART
- increase to paed moderate dose MART if not controlled
- use BD ICS/LABA + SABA PRN if MART not manageable
step 3 - add LTRA
- 8-12 week trial to assess effectiveness
refer if not controlled
chronic asthma treatment in <5
step 1 - SABA + paed low dose ICS
- SABA prn
- ICS BD
only 8-12 week trial - not long term
if symptoms do not resolve
- check adherence, inhaler technique, environmental factors
- refer to specialist
if symptoms resolve - stop treatment - review after 3 months
if symptoms reoccur in 3 months or acute ep requiring corticosteroids or hospitalisation:
- step 2 - restart ICS + SABA
start on paed low dose then titrate up to paed moderate dose
step 3 - add LTRA 8-12 weeks monitor effectiveness
refer
dropping down
drop down when asthma has been controlled for at least 3 months
regularly reviewed when decreasing treatment
pts should be maintained at lowest possible dose of ICS
- reductions considered every 3 months - only 25-50% of dose each time
we want to see complete control when dropping down or else do not reduce
what does complete control consist of?
no daytime symptoms
no night time awakening due to asthma
no asthma attacks
no need for rescue medication
no limitations on activity including exercise
normal lung function (FEV1/PEF at 80% predicted or best)
minimal side effects from treatment
