Severity of Asthma

Question 1

Explain the different severities of someone with acute asthma?

Answer 1

Moderate:

• Patient CAN talk
• RR: < 25 breaths/min
• < 110 beats/min
• O2 saturation >92%
• Peak flow >50%

Severe:

• Struggling to form a sentence
• > 25 breaths/min
• > 110 beats/min
• O2 saturation >92%
• Peak flow 33-50%

Question 2

What symptoms would someone have if their asthma was life-threatening?

Answer 2

• Silent Chest, Cyanosis (blueness)
• Hypotension, bradycarida
• O2 saturation <92%
• Peak flow <33%

Question 3

Explain the first two steps of the step ladder if a pt has chronic asthma.

Answer 3

Step 1: SABA (salbutamol)
if that would help
Step 2: ICS Inhaled corticosteriod

Question 4

What would determine someone going from step 1 to step 2?

Answer 4

1. Is the pt using their inhaler for more than 3 times a week?
2. Are they getting any nigh-time symptoms?
3. Have they had any exacerbations within the last 2 years?
   If yes to any, they would go from step 1 to step 2.

Question 5

If a person is still not getting relief, what would be the next steps?

Answer 5

Step 3: adding in a LABA (long acting beta 2 agonist - formeterol) + (Increase ICS if therapy is still inadequate)

If LABA isnt helping –> this must be stopped.
increase ICS dose
consider a trial of leukotriene receptor antagonist (LRA) or SR theophylline

Step 4: increase ICS dose + leukotriene receptor antagonist (LRA) or SR theophylline
(similar to STEP 3)

STEP 5: daily low dose of oral steroid tablet + high dose ICS
if this still doesn’t work - REFER to specialist

Question 6

whats the step ladder for children under 5?

Answer 6

Step 1: SABA
Step 2: ICS or LRA if corticosteriod cant be used
Step 3: LRA
step 4: REFER