Management of Asthma from Special Groups

What should not be started in asthmatic patients that are pregnant?

• should not start LTRA

What is magnesium sulphate used to treat?

• asthma exacerbations

• relaxes bronchial muscles and expands airways

How are asthma exacerbations treated?

• bronchodilators

• oral prednisolone

• magnesium sulphate

• High flow oxygen to maintain O2 saturation at 94-98%

What is considered well controlled asthma?

• no daytime symptoms

• no night-time wakening due to asthma

• no asthma attacks

• no limitations on exercise

• PEFR >80% (normal lung function)

If asthma is stable what can be considered for the treatment?

• consider reducing therapy if asthma has been stable for 6 months

  • evidence only really for reducing ICS strength

What is PEFR for moderate acute asthma?

• 50-75%

What is treatment for moderate acute asthma?

• normally treat at home

• SABA using a spacer (or nebuliser if available)

• prednisolone 40-50mg daily

• only admit to hospital if life threatening

What are clinical showcases of acute severe asthma?

• PEFR 33-50%

• unable to talk in sentences

• resp rate >25 breaths/min

• pulse >110bpm

What is treatment for acute severe asthma?

• consider hospital admission

• oxygen by venturi mask (maintain O2 sat at 94-98%)

• oral prednisolone 40-50mg

• nebulised/spacer SABA (spacer only if nebulised unavailable)

What oxygen saturation level is considered life threatening asthma?

What PEFR indicates life threatening asthma?

• <92%

• <33%

What is treatment for life threatening asthma?

• immediate hospital admission

• nebulised salbutamol and ipratropium (oxygen used as a driving gas)

• oral prednisolone 40-50mg

• oxygen via venturi mask for O2 sat 94-98%

• in hospital

  • IV aminophylline, salbutamol or terbutaline

  • IV fluids/electrolytes (especially K)

What oxygen saturation should be aimed for using venturi mask?

• aim for 94-98%

When should PEFR be measured?

• 15-30 mins after starting treatment (checking for improvement of 12+% and 200+ml

When are asthmatic patients with exacerbations discharged from hospital?

• when PEFR variation is less than 25%

• on inhaler therapy (no longer nebuliser)

• asthma action plan in place for the patient

What is SpO2, PEFR, HR and Resp rate in acute severe asthma in children?

• SpO2 <92%

• PEF 33-50%

• HR

  • >140bpm 1-5 years

  • >125 bpm for >5 years

• Resp rate

  • >40/min 1-5 years

  • > 30/min >5 years

What is SpO2 in life threatening asthma in children?

What symptoms accompany this SpO2 (1 or more + SpO2 indicates life threatening asthma)

• SpO2 <92%

• exhasution

• hypotension

• cyanosis

• silent chest

• poor resp effort

• confusion

• PEF <33%

In acute severe asthma in kids, what is a symptom?

• unable to complete sentences in one breath or too breathless to talk/feed

What is treatment for asthma attacks in children?

• high flow oxygen to achieve O2 sats 94-98%

• SABA nebulised (or spacer if unavailable)

• steroids (based on childs weight)