Asthma Exacerbation- Primary Care Setting Treatment and Assessment

Question 1

Asthma exacerbation assessment in an outpatient setting: History

Answer 1

Onset and cause of exacerbation

Severity of symptoms: dyspnea (anaphylaxis; any limiting exercise or disturbing sleep)

All medication use (reliever/controller), adherence, response to current meds (any recent dose changes)

Risk factors for death

Question 2

Asthma exacerbation assessment in an outpatient setting: PE; vitals

Answer 2

temperature, TACHYPNEA, TACHYCARDIA, BP, dry cough; ABILITY TO COMPLETE SENTENCES, LEVEL OF CONSCIOUSNESS

Question 3

Asthma exacerbation assessment in an outpatient setting: PE; respiratory exam

Answer 3

use of accessory muscle, wheezing, diminished breath sounds, cyanosis, hypoxic seizures

Question 4

Asthma exacerbation assessment in an outpatient setting: PE; objective information

Answer 4

DECREASED O2 SATURATION, PEF OR FEV1

Question 5

What other conditions should you look for in a respiratory exam?

Answer 5

HF, foreign body, PE, atelectasis

Question 6

What other complications should you look for in a respiratory exam?

Answer 6

Pneumonia, anaphylaxis, atelectasis, penumothorax

Question 7

Meds for outpatient asthma exacerbation (without specific doses)

Answer 7

SABA
Prednisolone
Controlled O2

Question 8

Outpatient asthma exacerbation treatment: SABA dose

Answer 8

4-10 puffs by pMDI and spacer; repeat q20mins x1 hour

Question 9

Outpatient asthma exacerbation treatment: prednisolone dose

Answer 9

Adults: 40-50mg
Children: 1-2mg/kg, 40mg MDD

Question 10

Outpatient asthma exacerbation treatment: O2 dose

Answer 10

Target O2 sat at 93-95%, 94-98% in children

Question 11

Continuation of outpatient asthma exacerbation treatment

Answer 11

SABA PRN; 4-10 puffs q304h or 6-10 puffs q1-2h and assess response at 1 hour (or earlier if necessary)

Question 12

If the patient is improving after assessment, what can you do?

Answer 12

Assess patient for discharge

Question 13

If the patient is worsening after assessment in the outpatient setting, what can you do?

Answer 13

Transfer to acute care facility; give SABA, ipratropium bromide, O2, systemic corticosteroid while waiting

Question 14

Assessment for discharge in the outpatient setting

Answer 14

Symptoms improved, don’t need a SABA

PEF improving and >60-80% of personal best or predicted

Oxygen saturation >94% on room air

Resources at home adequate

Question 15

What to arrange at discharge in the outpatient setting

Answer 15

Reliever: continue PRN

Controller: start one or step up; check technique and adherence

Prednisolone: continue for ~5-7 days (3-5 days for children)

Follow-up in 2-7 days

Question 16

Following up with a patient in after an outpatient asthma exacerbation

Answer 16

Review Sx and signs: is the exacerbation resolving? Should prednisone be continued?

Reliever: PRN

Controller: continue higher dose for short-term (1-2 weeks) or long term (3 months) depending on background to exacerbation

Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation, including inhaler technique and adherence, refer if >1-2 exacerbations/year