Exam 1 - Asthma (acute)

Question 1

What are risk factors for a severe acute asthma exacerbation or death? (8)

Answer 1

Hx requiring intubation/mechanical ventilation, hospitalization within last year, oral CS, not using ICS, SABA overuse, comorbidities (diabetes, pneumonia, psychiatric/social problems), food allergies, poor adherence

Question 2

How do patients in mild or moderate asthma exacerbations present?

Answer 2

talks in phrases, prefers sitting to lying, not agitated, RR increased, accessory muscles not used, tachycardia, O2 saturation 90-95%, PEF > 50%

Question 3

How do patients in severe asthma exacerbations present?

Answer 3

talks in words, sits hunched forwards, RR > 30, accessory muscles in use, very tachycardic, O2 < 90%, PEF < 50%

Question 4

What is the treatment for mild to moderate asthma exacerbations? (3)

Answer 4

SABA 4-10 puffs q20 min, prednisolone 40-50 mg, oxygen (target 93-95%)

Question 5

What else can be given for asthma exacerbations? (3)

Answer 5

ipatropium 8 puffs q20 min, magnesium 2 g IV, high-dose ICS

Question 6

How long should an oral corticosteroid be prescribed for after an asthma exacerbation?

Answer 6

5-7 days

Question 7

When should follow-up occur in the outpatient setting post asthma exacerbation?

Answer 7

1 week

Question 8

Which medications should not be used in asthma exacerbations? (8)

Answer 8

aminophyllines, LKAs, hydration, high-dose mucolytics, antihistamines, chest physiotherapy, sedation, antibiotics

Question 9

Why should nebulizers be avoided?

Answer 9

virus dissemination potential