Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath.
Ascertain precipitating factors.
Establish best known Peak expiratory flow rate predicted Peak expiratory flow rate based on age, sex and height.
Important to know severe or brittle they are- any intensive care unit admissions for intubation.
Are they known to be steroid responsive
Beware of “morning dippers”, recent acute severe attack, known “brittle” asthmatics, current or very recent use of steroids already, as these patients are at a high risk for a severe attack.
Assess severity including Peak expiratory flow rate before nebulisers are given but don’t delay treatment!!
Look for complications of asthma (pneumothorax, pneumomediastinum, Acute myocardial infarction, respiratory failure, electrolyte disturbance, hyperglycaemia etc).
Aterial Blood Gases if severe asthma, failure to respond rapidly.
CXR if failure to respond, severe, intubated or suspected complication (pneumothorax, pneumonia, aspiration or LVF).
· Salbutamol Nebulisation 5 mg
· Inform Medical Officer at an early stage if it doesn’t respond rapidly,
· High flow oxygen- keep saturation >95%,
· Salbutamol Neb 5 mg every 10-15 mins,
· Hydrocortisone 200 mg IV + Prednisolone 30 mg Orally,
· Observe for a period of 4 hours,
· Admission indicated if any failure to improve, deterioration, representation, prolonged attack or poor or remote social circumstances.
· Inform Medical Officer As soon as possible
· High flow O2- Keep saturation >95%,
· IV access x2,
· Continuous Salbutamol Nebulisations,
· Consider use of Ipratropium nebulisations,
· IV fluids 500mls bolus,
· Hydrocortisone 200 mg IV (4mg/kg in children) or Dexamethasone 6 mg IV,
· Consider IV Salbutamol infusion (250 IV bolus over 1 min. followed by 6 mg made up to 100mls of 5% Dextrose infused at 5-20 or in children 15mcg/kg bolus over 10 minutes followed by an infusion of 1-5mcg/kg/min) or
· Magnesium sulphate 2 g IV over 5-10 mins. (25-40 mg/kg over 20 mins in kids),
· Consider Adrenaline 0.5 ml 1:1000 SC,
· Consider Aminophylline infusion if not improving (Bolus of 5 mg/kg over 20 mins. Followed by infusion or 1 mg/kg/hr in children),
· Intubate early if developing exhaustion, altered conscious state,
· All those with severe bouts of asthma should be admitted.
Prior to discharge of any mild or significantly improved moderate asthmatic ensure:
· General knowledge is adequate,
· Inhaler technique OK and has enough supplies at home,
· Smoking cessation advice given,
· Steroids supplied for days
· “Asthma Action Plan” is current.