Asthma

Question 1

What are the best markers for severity in an acute attack?

What are poor markers?

Answer 1

Best:

• Conscious state
• Work of breathing

Poor

• Wheeze severity
• Pulsus paradoxus
• Peak expiratory flow

Question 2

What is the indication for oxygen therapy in asthma?

Answer 2

SaO2

- Not wheeze or work of breathing

Question 3

Why might tachycardia not be a good clinical indicator?

Answer 3

It’s a side effect of salbutamol

Question 4

Why isn’t SaO2 necessarily a good clinical indicator?

Answer 4

It purely reflects oxygenation

- Doesn’t reflect ventilation therefore CO2 retention could be occurring

Question 5

What does a mild asthma attack look like?

Answer 5

Normal conscious state
Subtle increase or no increase in WOB
Talking normally

Question 6

What does a moderate asthma attack look like?

Answer 6

Normal mental state
Some increased WOB
Tachycardia
Some limitation of ability to talk

Question 7

What does a severe asthma attack look like?

Answer 7

Agitated/distressed
Marked increase WOB
Tachycardia
Marked limitation in talking

Question 8

What does a critical asthma attack look like?

Answer 8

Drowsy/confused
Maximal WOB/exhausted
Tachycardia
Unable to talk
\+/- Silent chest

Question 9

How do you escalate therapy for mild to moderate?

Answer 9

Add oral prednisolone (2mg/kg for first day, only continuing at 1mg/kg if there is ongoing need for bronchodilators)
And O2 is sats less than 92%

Question 10

How do you escalate therapy from moderate to severe?

Answer 10

O2 if not already given
Add ipratropium, aminophylline, and magnesium sulphate
Consider IV pred if vomiting

Question 11

How do you escalate therapy from severe to critical?

Answer 11

Continuous nebulised salbutamol and ipratropium (consider IV sal)
IV methylpred

Question 12

How are mild asthma attacks treated?

Answer 12

Salbutamol 6 (under 6) or 12 puffs (over 6), review at 20 minutes, if good response discharge