Asthma

Question 1

Signs of mild asthma

Answer 1

1) normal mental state
2) subtle/ no increased WOB/ accessory muscle use
3) able to speak in full sentences

Question 2

Rx for mild asthma

Answer 2

Salbutamol by MDI/spacer
6puffs<6 yo
12 puffs>6yo
Review after 20 mins
Ensure technique good

If good response- discharge on B2 agonist PRN

If poor- Rx as moderate

Can give oral prednisolone for acute episodes not responsive to bronchodilator alone
2mg/kg (60mg) initially
Continue with 1mg/kg for further 1-2 days if ongoing need for SABA

Question 3

Signs of moderate asthma

Answer 3

1) normal mental state
2) some increased WOB/ accessory muscle use
3) tachycardia
4) some limitation in ability to talk

Question 4

Signs of severe asthma

Answer 4

1) agitated/ distressed
2) moderate- marked WOB/ accessory muscle use/ recession
3) tachycardia
4) marked limitation in ability to talk

Nb wheeze is a poor predictor of severity

Question 5

Signs of critical asthma

Answer 5

1) drowsy/ confused
2) maximal WOB/ accessory muscle use/ recession
3) exhaustion
4) marked tachyC
5) unable to talk

Silent chest

Question 6

Rx for moderate asthma

Answer 6

1) O2 if <92%
2) salbutamol MDI/ spacer 1 dose every 20 mins for 1 hour
r/v 10 mins after 3rd dose to reassess
3) oral prednisolone 2mg/kg (60mg), continue for 1-2 days 1mg/kg if ongoing need for SABA

Question 7

Rx for severe asthma

Answer 7

1) O2 if <92%
2) salbutamol by MDI/ spacer, 1 dose every 20 mins for 1 hour
R/V 10 mins after 3rd dose. If no change- Rx as critical
3) ipratropium MDI/ spacer every 20 mins for 1 hour only
4puffs<6yo
8 puffs> 6yo
4) aminophylline
If deteriorating/ very sick
Loading dose 10mg/kg IV over 1h
Then give continuous infusion
5) MgSO4 50%
6) oral pred or methyl prednisolone IV if vomiting
Involve senior staff, admit

Question 8

Discharge requirements

Answer 8

1) written asthma action plan
2) observe inhaler technique
3) advise GP follow up if condition deteriorates or if no significant improvement
4) arrange outpatient follow up with GP or paed
5) parent and child education, asthma foundation and info

Question 9

What Ix do you do?

Answer 9

None really

• CXR not indicated
• Blood gases distressing