Asthma exacerbation Flashcards
Give four presenting features of an acute asthma exacerbation
- Typical symptoms: especially nocturnal and early morning
- Wheeze
- Breathlessness
- Cough
- FHx of asthma or atopy
- Low PEFR
- Eosinophilia
Name five precipitating factors of asthma exacerbation
- Occupational irritants: flour, organic dust, pollution, solvents, perfumes
- Smoking
- URTIs: esp viral
- Cold air and exercise
- Emotional stress
- Drugs: NSAIDs, aspirin, beta-blockers Allergens
Request three investigations for acute exacerbation of asthma
- Peak expiratory flow
- Obs: RR; SaO2; HR
- FBC; eosinophils; U+Es
- CXR: consolidation; pneumothorax; life-threatening exacerbation
- ECG: exclude arrhythmias
- ABG if sats <92%
What are the categories of asthma exacerbation?
- Mild
- Moderate
- Severe
- Life-threatening: requires ITU and ventilation
- Near-fatal: requires ITU and ventilation
Define moderate asthma exacerbation
- PEFR 50-75%
- No features of severe of life-threatening asthma
Define severe asthma exacerbation
Any one of:
- PEFR 33-50%
- Respiratory rate >25
- Heart rate >110
- Cannot complete sentences in one breath
Define life-threatening asthma exacerbation
Any one of:
- PEFR <33%
- SaO2 <92%, or PaO2 <8kPa
- Normal PaCO2
- Cyanosis, poor respiratory effort, or silent chest
- Exhaustion; confusion or coma; hypotension; arrhythmias
Define near-fatal asthma exacerbation
Raised PaCO2
Outline the management of moderate acute asthma exacerbation
- ABC assessment
- Controlled oxygen for SaO2 94-98%
- ABG if <92%
- 5mg nebulised salbutamol (can repeat after 15min)
- 40mg oral prednisolone or 100mg IV hydrocortisone
What additional management steps are involved in acute severe asthma exacerbation?
Moderate exacerbation management, plus:
- Inform senior; consider ABG
- Nebulised Ipratropium bromide 500mcg
- Consider back to back Salbutamol every 15min
What additional management steps are involved if life-threatening or near-fatal asthma exacerbation?
Moderate + severe exacerbation management, plus:
- ITU/anaesthetist assessment
- Urgent portable CXR
- Consider IV magnesium sulphate
- Consider IV Aminophylline 5mg/kg
List the criteria for safe asthma discharge after exacerbation?
- PEFR >75% and been off regular nebulisers for 24h
- Smoking cessation and nicotine replacement therapy
- Inpatient asthma nurse review:
- Education and appropriate prescription
- Reassess inhaler technique and adherence
- Provide PEFR meter and Personal Asthma Action Plan
- 5+ days oral prednisolone
- GP follow-up within 48h
- Consultant follow-up in clinic within 4/52
What is a Personal Asthma Action Plan?
A guide to help the patient:
- Manage everyday asthma care
- Recognise symptoms of an asthma attack
- Steps to take if an asthma attack occurs
