Asthma: Acute adults

Question 1

The severity of an asthma exacerbation is graded as moderate, severe, life-threatening and near-fatal. Outline the criteria for moderate acute asthma in adults (3)

Answer 1

1) Peak flow > 50–75% best or predicted
2) increasing symptoms
3) normal speech, with no features of acute severe or life-threatening asthma.

Question 2

Outline the criteria for severe acute asthma in adults (4)

Answer 2

Any one of the following:

1) Peak flow 33-50% best or predicted
2) Respiratory rate ≥ 25/min
3) Heart rate ≥ 110/min
4) Inability to complete sentences in one breath

Question 3

Outline the criteria for life-threatening acute asthma in adults

Answer 3

1 of the following, in a patient with severe asthma:

2) Peak flow < 33% best or predicted
2) SpO2: < 92%
3) PaO2: < 8 kPa
4) PaCO2 4.6–6.0 kPa (Normal partial arterial pressure)
5) Silent chest
6) Cyanosis
7) Poor respiratory effort
8) Arrhythmia
9) Exhaustion
10) Altered conscious level
11) Hypotension

Question 4

Outline the criteria for near-fatal acute asthma in adults

Answer 4

Raised PaCO2, requiring mechanical ventilation with raised inflation pressures, or both

Question 5

which grade of patients should be given supplementary oxygen, and what level should SpO2 be maintained between?

Answer 5

1) All hypoxaemic patients with acute severe asthma

2) Maintain a SpO2 level between 94–98%.

Question 6

With regards to the severity of acute asthma, which grade of patients can be treated at home and which ones need to be admitted to secondary care?

Answer 6

1) Moderate asthma should be treated at home or in primary care
2) severe or life-threatening acute asthma should be admitted to hospital immediately

Question 7

what is the first-line treatment for acute asthma and how should this be given in the following patients:

a) non-life-threatening acute asthma
b) life-threatening acute asthma

Answer 7

1) high-dose inhaled short-acting SABA (salbutamol or terbutaline sulfate) given ASAP
a) pMDI + spacer in patients with non-life-threatening
b) life-threatening acute asthma a oxygen-driven nebuliser is recommended

Question 8

Who would be given SABA via the IV route?

Answer 8

reserved for those patients in whom inhaled therapy cannot be used reliably

Question 9

How should patients be managed if their response to an initial dose of SABA is poor?

Answer 9

1) Continuous nebulisation with an appropriate nebuliser
2) Nebulised ipratropium bromide may be combined with a nebulised b2-agonist in patients with acute severe or life-threatening asthma to provide greater bronchodilation.

Question 10

1) In all cases of acute asthma, patients should be prescribed an adequate dose of steroids. State which steroid would be prescribed and for how long
2) what alternative steroids could be prescribed in adults if this drug is not tolerated?

Answer 10

1) oral prednisolone - Adult or child over the age of 12 years - 40–50 mg once a day for 5 days or until recovery.
2) IM methylprednisolone (160mg) as an alternative in adults, or IV hydrocortisone (100mg)

Question 11

There is some evidence that magnesium sulfate has bronchodilator effects. When would this drug be considered in acute asthma? (specialist)

Answer 11

A single IV dose in those with severe acute asthma (peak flow < 50% best or predicted) who have not had a good initial response to inhaled bronchodilator therapy

Question 12

IV aminophylline is not likely to produce any additional bronchodilation compared to standard therapy in acute asthma. when would IV aminophylline be used?

Answer 12

near-fatal or life-threatening acute asthma with a poor response to initial therapy