prescribing in asthma

Question 1

if you think someone might be having an acute severe asthma attack, what is the very first thing you do?

Answer 1

assess the severity of the attack. - the severity of an attack is easily underestimated. they will be acutely breathless and wheezy.

assess: 
1 - ability to speak
2 - RR,
3 -  PR, 
4 - PEF

severe attack is:
1 - unable to complete sentences
2 - RR over 25
3 - PR over 110
4 - PEFR 33-50% of predicted or best

life threatening if:
1 - PEFR under 33%
2 - silent chest, cyanosis, feeble resp effort
3 - bradycardia or hypotension
4 - exhaustion, confusion or coma.
5 - ABG will show resp failure and acidosis

If severe or life threatening you should warn ICU in advance.
I think you treat by the worst variable but ultimately if they can’t speak sentences when you come in the room then you know its very bad.

Question 2

what is the immediate treatment of a severe asthma attack

Answer 2

1 - salbutamol 5mg NEB in oxygen
2 - prednisolone 50mg PO , add hydrocortisone 100mg IV if very ill
3 - oxygen based on saturations (check ABG)

Question 3

if there are life threatening features present what additional things do you do?

Answer 3

1 - get help, inform ICU.
2 - salbutamol NED 15mg NEB every 15 min. (watch ECG for arrhythmias)
3 - ipratropium 0.5mg NEB
4 - Magnesium Sulfate 2g IV over 20 min

Question 4

if an acute severe asthma attack fails to respond to extended treatment what do you do?

Answer 4

if the PT fails to respond and continues to have life threatening features or is deteriorating then you get ICU involved for:
1 - ventilation
2 - aminophylline, salbutamol IV. etc

Question 5

if a PT with a severe or life threatening attack responds to treatment over 15-30 mins, what do you do?

Answer 5

1 - salbutamol 5mg NEB every 4 hours
2 - prednisolone 50 mg PO OD for about a week
3 - Monitor PEFR and saturations.