Acute Asthma

Question 1

What is acute asthma?

Answer 1

An acute exacerbation of asthma is characterized by a rapid deterioration in symptoms.

Question 2

Acute asthma triggers include

Answer 2

typical asthma triggers such as infection, exercise, or cold weather

Question 3

What are some patient presentations that would indicate acute asthma?

Answer 3

• Progressively worsening shortness of breath
• Use of accessory muscles
• Fast respiratory rate (Tachypnoea)
• Symmetrical expiratory wheeze on auscultation
• The chest can sound “tight” on auscultation with reduced air entry

Question 4

When should a patient be hospitalized after an acute asthma attack?

Answer 4

If it is moderate/severe

Question 5

What physiological values would you expect to see in a patient with mild/moderate acute asthma?

Answer 5

• PEFR 50-75% predicted

Question 6

What physiological values would you expect to see in a patient with severe acute asthma?

Answer 6

• PEFR 33-50% predicted
• Respiratory rate > 25
• Heart rate > 110
• Unable to complete sentences

Question 7

What physiological values would you expect to see in a patient with life-threatening acute asthma?

Answer 7

• PEFR < 33%
• Oxygen Saturation < 92%
• Becoming tired
• Heart rate > 130 (Bradycardiac)
• No wheeze. This occurs when the airways are so tight there is no entry at all. This is ominously described as a “silent chest”
• Haemodynamic instability (i.e. shock)
• Grunting
• Hypoventilating
• Cyanosis

Question 8

What physiological values would you expect to see in a patient with near-fatal acute asthma?

Answer 8

Raised partial pressure of carbon dioxide

Question 9

What treatment options are available for patients suffering from moderate acute asthma?

Answer 9

• Nebulised Beta-2 agonists (i.e. salbutamol 5mg repeated as often as required)
• Nebulised Ipratropium Bromide
• Steroids. Oral Prednisolone or IV hydrocortisone. Usually continued for 5 days.
• Antibiotics if there is convincing evidence of bacterial infection

Question 10

What treatment options are available for patients suffering from severe acute asthma?

Answer 10

• Oxygen if required to maintain sats 94-98%
• Aminophylline infusion
• Consider IV salbutamol

Question 11

What treatment options are available for patients suffering life-threatening acute asthma?

Answer 11

• IV magnesium sulfate infusion
• Admission to HDU or ICU
• Intubation in the worst cases. This decision should be made early because it is very difficult to intubate with severe bronchoconstriction

Question 12

What does near-fatal asthma require?

Answer 12

Mechanical ventilation

Question 13

What are the ABG’s in asthma?

Answer 13

Initially, patients will have a respiratory alkalosis as tachypnoea causes a drop in CO2. A normal PCO2 or hypoxia is a concerning sign as it means they are tiring, it indicates life-threatening asthma. A respiratory acidosis due to high CO2 is a very bad sign in asthma.

Question 14

How can you monitor the responses to treatment?

Answer 14

• Respiratory Rate
• Respiratory Effort
• Peak flow
• Oxygen saturation
• Chest auscultation

Question 15

Why should you monitor serum potassium when on salbutamol?

Answer 15

Salbutamol causes potassium to be absorbed from the blood into the cells. It also causes tachycardia.

Question 16

How should you discharge patients after treating their asthma attack?

Answer 16

• Discharge them with an asthma action plan
• Consider prescribing a rescue pack of steroids for the person to initiate in the future if they have another exacerbation

Question 17

According to NICE, after how many attacks should you refer your patient to a respiratory specialist?

Answer 17

After 2 attacks in 12 months