Asthma Flashcards
List 4 characteristic clinical features of asthma
- cough
- Dyspnoea
- Wheeze
- Chest tightness
List the features that characterise a moderate asthma attack
- Worsening symptoms
- No features of acute severe asthma
- PEFR >50% of best/predicted
List the features that characterise an acute severe asthma attack
- Inability to complete sentences in a single breath
- PEFR <50% of best/predicted
- RR ≥ 25
- HR ≥ 110
List the features that characterise a life-threatening asthma attack
- Poor respiratory effort
- Cyanosis
- Silent chest
- Hypotension
- Arrhythmia
- Exhaustion
- Reduced conscious level
- PEFR < 33% of best/predicted
- SpO2 < 8KPa
- Normal PaCO2 = 4.6 - 6.0 kPa
What is the initial treatment for acute asthma?
- Sit upright
* Salbutamol 5mg and ipratropium bromide 0.5 mg via oxygen-driven nebuliser
Should patients display an inadequate response to initial therapy, what further treatments can be given?
- Repeat salbutamol 5mg via oxygen-driven nebuliser if inadequate response and give prednisolone 40mg orally (PO) or hydrocortisone 100mg IV if unable to swallow.
- Consider “back-to-back” salbutamol nebulisers or continuous salbutamol nebuliser 5-10 mg/h if inadequate response.
- Consider magnesium sulphate 1.2-2.0g IV over 20 minutes in life threatening or near-fatal asthma or in acute severe asthma with an inadequate response to initial therapy
- consider aminophylline 5 mg.kg IV loading dose over 20 minutes followed by 0.5 mg/kg/h IV maintenance dose in life-threatening or near-fatal asthma with an inadequate response to initial therapy.
What features would concern you on an ABG in acute asthma?
- Low pH
- PaCO2 >4.6kPa
- PaO2 < 8kPa
What are the indications for requesting a CXR in acute asthma?
- suspected pneumothorax or consolidation
- life threatening asthma
- Failure to respond to initial therapy
- Requirement for ventilation
What criteria would mandate admission for acute asthma?
- Life-threatening asthma
- Near-fatal asthma
- Acute severe asthma persisting despite initial therapy
What criteria must be achieved to consider discharge following acute asthma?
- PEFR > 75% of best/predicted 1 hour after initial therapy
What would you check before discharge?
- Give prednisolone 40 mg once daily for 5 days
- Check inhaler technique and ensure sufficient, in-date inhaled bronchodilator
- Arrange follow up with GP in two days
What is the definition of asthma and what are the 3 main components?
- Chronic inflammatory disease of the airways.
- 3 components:
1. Reversible and variable airflow obstruction
2. Airway hyper-responsiveness to stimuli
3. inflammation of the bronchi
What is the Epidemiology of Asthma?
- Increasing prevalence - estimates of prevalence range from 3-5.4 million
- Approximately 235 million people worldwide affected
- Approximately 250,000 people die per year form the disease
What is the aetiology of asthma?
- Atopy and allergy - pets, pollen
- cold air
- Exercise
- Pollution
- Occupational
- e.g. isocyanates (paint sprayers), latex, flour, and grain dust
- Viral infections
- Drugs
- E.g. NSAIDs, Beta Blockers
- Emotion
What are the main presentations of asthma?
- Cough
- Wheeze
- Breathlessness
- Chest tightness
Which features increase the probability of asthma?
- Diurnal variation (worse at night and early morning)
- Triggered by or made worse by aetiologies e.g. cold air
- Recurrent and frequent symptoms
- Family history of atopy or asthma