Asthma Exacerbations (exam 2) Flashcards
asthma exacerbation
episode of progressive increase in asthma symptoms
asthma exacerbation occurs as a result of
exposure to external agents
poor adherence to controller medication
preferred term to tell patients for asthma exacerbation
flare up
all patients should have a
written asthma action plan
how does an asthma action plan help a patient with self management?
how to identify worsening asthma
changes to reliever and controller if symptoms worsen
when to use OCS
when to seek medical care
green zone of asthma action plan
no limitation of activities
no nighttime awakenings
reliever use less than 3 times/week
no cough, wheezing, SOB, tightness of chest
PEF greater than 80%
yellow zone of asthma action plan
some limitation, but still can do some activities
nighttime awakenings
increased symptoms and reliever use
PEF 50-79%
red zone of asthma action plan
cannot do usual activities
very SOB
reliever needed more than 3-4 hours
no improvement/worsening after less than 24 hours in yellow zone
PEF less than 50%
Reliever changes for exacerbations
increase frequency of low dose budesonide/formoterol, SABA or ICS-SABA
MART controller changes for exacerbations
continue usual maintenance dose
increase reliever
maintenance ICS with SABA as reliever controller changes for exacerbations
quadruple ICS dose
maintenance ICS-formoterol with SABA as reliever controller changes for exacerbations
quadruple maintenance ICS-formoterol
maintenance ICS plus other LABA with SABA as reliever controller changes for exacerbations
step up to higher dose formulation of ICS plus LABA
consider adding separate ICS inhaler to quadruple ICS dose
when to give oral corticosteroid therapy for exacerbations
patient doesn’t respond to increase reliever and controller medication after 2-3 days
deteriorates rapidly
PEF/FEV1 less than 60%
history of sudden severe exacerbations
course of therapy for OCS in adults?
children?
adults 5-7 days
3-5 days
mild-moderate exacerbation
not agitated
talks in phrases
prefers sitting to lying
accessory muscles not used
RR less than 30 breaths/min
plus rate 100-120 bpm
O2 90-95%
PEF over 50%
severe exacerbation
agitated
talks in words
hunched
RR over 30 breaths/min
accessory muscles used
pulse rate over 120 bpm
O2 under 90%
PEF less than 50%
treatment for mild-moderate exacerbation in primary care setting
SABA
OCS
oxygen
treatment for severe exacerbation in primary care setting
transfer to acute care facility
start with SABA, SAMA, oxygen and systemic steroid
initial assessment in the ED for asthma exacerbations
ABCs
a - airway
b- breathing
c - circulation
when would someone go to the ICU for an asthma exacerbation?
drowsiness
confusion
silent chest
treatment for mild-moderate asthma exacerbation in the ED
SABAs
consider ipatropium bromide
oral corticosteroids
oxygen
treatment for severe asthma exacerbation in the ED
SABAs
ipatropium bromide
oxygen
oral or IV corticosteroids
consider IV magnesium, high dose ICS
discharge planning for asthma exacerbation
reliever PRN
continue course of oral corticosteroid
continue on ICS at inc step
follow up appointment with primary care 2-7 days after discharge
what is the preferred regimen post discharge from ED?
budesonide-formoterol MART
systemic corticosteroids
most effective anti-inflammatory
improvement observed in 4 hours
oral corticosteroids MOA in treatment of asthma exacerbations
reduces mucus production
reduces airway edema
reduces bronchial hyperresponsiveness
increases number of B2 receptors and improves responsiveness
is IV or oral corticosteroids better for asthma exacerbations?
both are equal!
IV given to those who cannot take by mouth
dose and effect of systemic corticosteroids
minimize dose and duration to minimize adverse effects
5-7 days of OCS
if corticosteroid therapy is long, there is risk for
the body producing less cortisol
when should corticosteroids be tapered
for therapy over 2 weeks
and
long term of high doses
why do we taper corticosteroids?
prevents cortisol deficiency
prevents sudden worsening of symptoms
do we have to taper steroids for asthma exacerbations?
no!
regimen is only 5-7 days
when should magnesium sulfate be used for asthma exacerbations?
severe exacerbations not responding to initial treatment
adverse effects of magnesium sulfate
hypotension
facial flushing
sweating
depressed deep tendon reflexes
hypothermia
cardiac, CNS and respiratory depression
MOA of magnesium sulfate
blocks calcium ion influx into smooth muscle which results in bronchodilation and anti inflammatory effects
