Asthma treatment plan

Question 1

How should peak flow be measured?

Answer 1

1. Patient in standing position (new mouth piece if needed)
2. Deep breath in, breathe all the way out.
3. From full expiration take a deep breath in, then;
4. Put peak flow meter mouthpiece between lips and seal lips tightly.
5. At full inspiration, breathe out as fast and hard as possible.
6. Repeat 3 times with the rest of 1-2 minutes between each blow.

Question 2

Other than peak flow, what other diagnositic processes are there WRT respiratory examinations?

Answer 2

Check pulse rate
Check respiratory rate
Measure oxygen saturation with pulse oximeter if available.

Question 3

In classifying the severity of acute asthma, what would class as a moderate exacerbation?

Answer 3

Increasing symptoms.
PEF 50-75% best/predicted.
No features of severe asthma.

Question 4

What would class as an acute severe asthma attack?

Answer 4

PEF 33-50% of best/predicted.
RR > or = 25 breaths/min
Pulse > or = 110 beats/min
Cannot complete sentences in one breath

Question 5

What would class as a lifethreatening asthma attack?

Answer 5

PEF <33% best
Sp02 <92%
PaO2 <8kPa
Normal PaCO2 (4.6-6 kPa)
Slient chest
Cyanosed
Poor respiratory effort
Arrhythmia
Exhaustion/altered consciousness.

Question 6

A PEF of below what is classed as life threatening in an asthma attack?

Answer 6

33%

Question 7

A SpO2 of less than what is classed as life threatening?

Answer 7

SpO2 <92%

Question 8

A PaO2 of what indicated life threatening asthma attacks?

Answer 8

<8kPA

Question 9

What is the target SpO2

Answer 9

94-98

Question 10

All nebulisers should be driven with what?

Answer 10

Oxygen

Question 11

What is the dose and timings of the administration of Salbutamol nebulised in moderate and severe asthma attacks?

Answer 11

Mod/Severe Acute: 5mg every 10-20 minutes.

Question 12

What is the dose and timings of the administration of Salbutamol nebulised in life threatening asthma?

Answer 12

Salbutamol 5mg every 10-20 mins or PRN.

Question 13

What corticosteroid would be used to treat moderate acute asthma? What route?

Answer 13

Prednisolone ORAL 40-50mg stat (then od for at least 5 days).

Question 14

For how long after the moderate acute asthma attack should oral prednisolone be taken ?

Answer 14

Prednisolone ORAL 40-50mg stat (then od for at least 5 days).

Question 15

What corticosteroids and at what doses and routes can be of use in the treatment of Severe acute and Life threatening ashtma?

Answer 15

Prednisolone ORAL 50mg STAT (then od for at least 5 days) OR

IV hydrocortisone 100mg STAT then 6 hourly until oral route acceptable.

Question 16

What route is hydrocortisone given in the treatment of severe acute/life threatening asthma attacks? What dose?

Answer 16

IV hydrocortisone 100mg STAT

Then 6 hourly until the oral route is acceptable.

Question 17

What form and strength of ipratropium bromide is of use in asthma treatment? when is it of use?

Answer 17

Severe acute: Use if response to O2, steroids, and beta-agonists is poor. 500mcg STAT and 4-6 hourly.

Life threatening: 500mcg 4-6 hourly.

Nebulised form - driven with oxygen.