Asthma - Acute

Question 1

What is acute asthma? (6)

Answer 1

Deterioration of symptoms over hrs/days.
Increasing breathlessness, wheezing, coughing and tightness.
Difficulty talking in sentences
Tachycardia
Tachypnoea
Reduced PEFR, O2.

Question 2

What are the red flags of acute asthma? (6)

Answer 2

Consciousness
Exhaustion
Cyanosis
Use of accessory muscles
Low O2 sats.
Confusion

Question 3

What are the main features of moderate acute asthma? (6)

Answer 3

PEFR 50-75% of baseline
Normal speech, HR, RR, o2 saturations.
No features of severe/life-threatening acute asthma.

Question 4

What are the main features of severe acute asthma? (6)

Answer 4

1 or more:
- PEFT 33-50% of baseline.
- Inability to complete sentences in 1 breath.
- RR > 25 breaths per minute (normal: 12-20)
- HR > 110 bpm (normal 60-100)
- O2 saturation: > 92%
- No features of life threatening acute asthma.

Question 5

What are the main features of life-threatening acute asthma? (9)

Answer 5

1 or more:
- PEFR < 33% of best
- O2 saturations - < 92%
- Altered consciousness
- Exhaustion
- Cyanosis
- Use of accessory muscles
- Hypotension
- Arrhythmia
- Silent chest on auscultation

Question 6

What are the key treatment options for acute asthma? (5)

Answer 6

O2
Oral CS
SABA
SAMA
Mg sulphate

Question 7

What should be offered to patients with acute asthma attacks in GPs? (1)

Answer 7

2 days follow up

Question 8

What is the PEFR and diurnal variation the patient must achieve before discharge? (2)

Answer 8

> 75% of best before discharge
< 20% before discharge

Question 9

What are the treatment options for moderate acute asthma? (3)

Answer 9

Salbutamol 100mcg given via spacer device
4 initial doses followed by 2 doses every 2 minutes according to response (max 10 doses)
Prednisolone 40mg OD for 5 days.

Question 10

What are the treatment options for acute severe and acute life-threatening asthma? (6)

Answer 10

Admit to hospital
SABA given via o2 driven nebuliser
Salbutamol 5mg nebules every 20-30 mins reduced to prn with symptom improvement.
Prednisolone 40mg OD for 5 days.
Use IV hydrocortisone 100mg QDS if px can’t swallow.
If response with salbutamol nebules suboptimal, add Ipratropium 0.5mg nebules given TDS/QDS a day.

Question 11

What treatment is not recommended to use for acute asthma? (1)

Answer 11

ABx unless evident of infection.

Question 12

Explain the use of Prednisolone for acute asthma. (4)

Answer 12

Given using 5mg tablets: (40mg = 8 tabs)
Dose given as single dose OM
Given with food
Only 5 days (short course)
- ADR: mood changes, GI disturbances.

Question 13

Explain the management of acute asthma in children. (3)

Answer 13

SABA
Steroids
Ipratropium bromide.