Worsening asthma Flashcards
HPC
What symptoms are you getting?
- Cough
- SOB
- Wheeze
When is it worse?
- Diurnal variability (worse in morning) is a key marker of poor control
Recent illnesses? - may be related to an exacerbation
3 questions:
- Have you had difficulty sleeping due to asthma sx?
- Have you had your usual Sx during the day?
- Has your asthma interfered with your usual activities?
PMH
Any previous asthma attacks?
How were these managed?
Any hospital admissions due to asthma (especially ITU)?
Any other problems with your lungs?
Other PMH
DH
How often would you use your inhalers before this?
How often now?
Compliance with inhalers?
Up to date with vaccinations?
- pneumococcus and flu
SH
Smoking
Triggers in job
Housing conditions - damp, pets?
Examination and investigations
Obs - HR, BP, RR, Obs
Peak flow - best of 3 - what is their normal?
Listen to chest
Treatment
- Encourage to use peak flow diary and look for worsening values (sign of poor control)
- Advise how to recognise poor control e.g. gradually worsening symptoms
- Advise how to recognise exacerbations e.g. sudden persistent worsening of symptoms
- Stop smoking
- Keep up to date in vaccinations
- Avoid triggers - e.g. pets
- Discuss inhaler technique
- Suggest that may need to change regime e.g. step up SABA or start a LABA
Exacerbations:
- Use blue inhaler (via a spacer)
- Give 4 puffs initially, followed by 2 puffs every 2 minutes up to 10 puffs. Repeat every 10–20 minutes according to response
- If cant complete sentences or are starting to tire - go to A&E or dial 999
SN
See the GP if Sx and PEFR do not improve.
Go to A+E if you are very breathless (eg you can’t finish a sentence) or you feel tired
