Asthma Acute Assessment and Management

Question 1

How do patients with moderate asthma present?

Answer 1

• PEFR > 50% best or predicted
• Speech normal
• RR <25/min
• Pulse <110bpm

Question 2

How do people with severe asthma present?

Answer 2

• PEFR 33-50% best or predicted
• Can’t complete sentences
• RR > 25/min
• Pulse > 110bpm

Question 3

How do people with life threatening asthma present?

Answer 3

• PEFR <33% best or predicted.
• O2 sats <92%
• Silent chest, cyanosis or feeble respiratory effort.
• Bradycardia, dysrhythmia or hypotension.
• Exhaustion, confusion or coma.

Question 4

How do you manage moderate asthma?

Answer 4

• Inhaled salbutamol or via a spacer (4-6 puffs).
• If PEFR between 50-75% then prednisolone.

Question 5

How do you manage severe asthma?

Answer 5

• consider admission
• oxygen to hypoxaemic patients to maintain a SpO2 of 94-98%
• beta 2 agonists such as salbutamol, either nebulised or via a spacer (4-6 puffs, given one at a time and inhaled separately, repeated at intervals of 10-20 minutes)
• prednisolone 40-50mg
• if no response then admit

Question 6

How do you manage life threatening asthma?

Answer 6

• arrange immediate admission (999 call)
• oxygen to hypoxaemic patients to maintain a SpO2 of 94-98%
• nebulised beta 2 agonists (e.g. Salbutamol) + ipratropium
• prednisolone 40-50mg or IV hydrocortisone 100mg