Treatment Summaries - acute asthma

Question 1

what parameters are reduced marking an acute exacerbation of asthma?

Answer 1

peak expiratroy flow rate
FEV1

Question 2

T/F: most ashtma attacks severe enough to require hospitalisation develop rapidly over 1 hour

Answer 2

false - they develop slowly over a period of 6 hours

Question 3

what is a common trigger for intermittent wheezing attachs in children?

Answer 3

viral infections
low birth weight and/or prematurity

Question 4

what 3 factors describe moderate acute asthma?

Answer 4

1. increasing symtpoms
2. peak flow >50 - 75% best or predicted
3. no features of acute severe asthma

Question 5

give 4 features of acute severe asthma, how many features must a person have to have severe acute asthma?

Answer 5

1. peak flow 33 - 50% best or predicted
2. resp rate > 25/min
3. heart rate >110/min
4. inability to complete scentences in one breath
   just need one feature

Question 6

Name 5 features of life-treatening acute asthma

Answer 6

1. peak flow <33% best or predicted
2. arterial oxygen saturation (SpO2) <92%
3. partial arterial pressure of oxygen <8kPa
4. silent chest
5. cyanosis
6. altered consiousness
7. silent chest
8. normal partial arterial pressure of CO2 (paCO2) (4.6 - 6.0kPa)

Question 7

whats the sign of near-fatal acute asthma?

Answer 7

raised PaCO2 and/or need for mechanical ventilation with raised inflation pressures

Question 8

Give 5 signs of moderate acute asthma in children and how do these change in severe acute asthma?

Answer 8

1. able to talk in scentences = cant complete scentences
2. arterial oxygen saturation (SpO2) >92% = <92%
3. peak flow >50% best or predicited = 33 - 50% best or predicted
4. HR <140 in 1 - 5yrs, HR <125 in children over 5 = >140/min in 1 - 5yrs, >125/min in 5yrs+
5. RR <40/min in 1 - 5yrs, <30/min in 5yrs+ = >40/min in 1 - 5 yrs and >30/min in 5yrs+

Question 9

when would a hospital referral be warranted in adults with moderate acute asthma?

Answer 9

poor response to treatment, social circumstances or concomitat disease

Question 10

what should be given to all hypoxaemic pateints with severe acute asthma?
what arterial oxygen saturation do we aim for?
Do you delay is pulse oximetry is unavailable?

Answer 10

give supplementary oxygen
94 - 98%

Question 11

how would you deliver salbutamol to someone with mild to moderate actute asthma compared to severe?

Answer 11

mild to moderate - give as pressurised metered dose inhaler, severe - give via oxygen driven nebuliser

Question 12

what should all patients be prescribed in acute asthma in combination with inhaled corticosteorids

Answer 12

oral prednisolone

Question 13

what therapy can be given in combination with a nebulised beta2 agonist in patients with severe/life threatening asthma or have poor response to SABAs?
what class is it?

Answer 13

ipratropium bromide
antimuscarinic

Question 14

when could aminophylline be considered?

Answer 14

in patients with near-fatal or life-threatening acture asthma but in acute asthma attacks its not likely to give additional bronchodilation compared to standard therapy

Question 15

when could magnesium sulfate be considered?

Answer 15

in patients with severe acute asthma with peak flow <50% best or predicited

Question 16

what setting should all acute asthma attacks under 2yrs be treated?
what about under 1yrs

Answer 16

hospital
under 1 - under direct guidance of respiratory paediatrictian

Question 17

outline the management for moderate and severe acute ashtma attacks in under 2yrs (3 points)

Answer 17

1. immediate treatment with oxygen via a tight fitting face mask or nasal prongs to achieve SpO2 94 - 98%
2. trial inhaled SABA -
3. if response poor combine nebulised ipratropium bromide to each SABA dose

Question 18

when and how long can prednisolone be given for children under 2?

Answer 18

in severe asthma attacks,
use daily for up to 3 days

Question 19

when should children over 2 be reffered to hospital for acute asthma attacks?
what should be given on arrival to hospital - what targets are you aiming for?

Answer 19

when severe or life-threatening
or fails to respond to treatment
give high flow oxygen via tight fitted mask or nasal cannula to achieve SpO2 94 - 98%

Question 20

how is the management in mild - moderate different in children to adults

Answer 20

SABA given via pMDI with spacer in children

Question 21

when should parents/careres of children with acute asthma at home seek urgent medical attention if symptoms not releived after how many puffs of salbuamol?

Answer 21

10 puffs via a spacer

Question 22

when should urgent medical attention be sought for children (return of symptoms)
what can be done whilst waiting for help?

Answer 22

if symptoms return in 3 - 4 hours
give an additional 10 puffs of salbutamol via spacer

Question 23

when treating children over 2 with prednisolone…
- what course should be long enough?
- what should you do in children who vomit?
- should you continue inhaled corticosteroids?

Answer 23

• 3 days should be enough but course should be tailored for number of days needed for recovery
• repeat dose or consider IV route
• good practice to continue inhaled corticosteroids, not to be used as replacement for the oral corticosteroid

Question 24

when can ipratroptium be given to children over2?

Answer 24

poor response to SABA to provide greater bronchodilation

Question 24

when can ipratroptium be given to children over2?

Answer 24

poor response to SABA to provide greater bronchodilation

Question 25

when can you give magnesium sulfate (unlicensed) to children over 2?

Answer 25

can add to SABA/ipratropium in the first hour in children with a short duration of severe acute asthma symptoms presenting with oxygen sat <92%

Question 26

what is given and what needs to monitored in children over 2 in a severe attack not responding to first line treatments?

Answer 26

• single IV bolous salbutamol
• continuous ECG and electrolyte monitoring

Question 27

when can you consdier aminophylline in children over 2 ?

Answer 27

in severe or life treatening acute asthma unpresonsive to maximal doses of bronchodilators and corticosteorids