1 / 20

Acute severe asthma

Acute severe asthma. Acute severe asthma : who is at most risk ?. Previous life-threatening attacks Severe disease (3 or >3 drugs for control; emergency steroid in past ; ever admitted in last 1 year) Psychiatric morbidity Non-compliance Requiring 2 or > 2 Bronchodilator inhalers monthly.

sconroy
Download Presentation

Acute severe asthma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acute severe asthma

  2. Acute severe asthma :who is at most risk ? • Previous life-threatening attacks • Severe disease (3 or >3 drugs for control; emergency steroid in past ; ever admitted in last 1 year) • Psychiatric morbidity • Non-compliance • Requiring 2 or > 2 Bronchodilator inhalers monthly

  3. Near fatal episodes • Misuse of drugs/alcohol • Psychiatric illness • Denial • Non compliance • Learning difficulties • Previous admission to ICU for asthma • Brittle asthma • Social isolation, income and employment difficulties • Previous self discharge from hospital Br Med J 2005;330585-9

  4. What is acute severe asthma ? ANYONE OF: • PEF 33-50% best or predicted • RR 25/min • Heart rate  110/min • Inability to complete sentences in one breath

  5. What is life threatening asthma ? ANYONE OF: • PEF < 33% best or predicted • Sat O2 <92% • PaO2< 55 mm Hg • Normal PaCO2 • Silent chest • Cyanosis • Feeble respiratory effort • Heart rate  110/min • Inability to complete sentences in one breath

  6. Contd……. • Bradycardia • Dysrhythmia • Hypotension • Exhaustion • Confusion • Coma

  7. What is near fatal asthma? • Increased PaCO2 • Requiring mechanical ventilation

  8. What is brittle asthma? • Type 1… > 40% diurnal variability in PEF for > 50% of the time over a period > 150 days despite intense therapy • Type 2 … sudden severe attacks on a background of apparently well controlled asthma

  9. Criteria for hospital admission • Near fatal attack  ADMIT IN ICU • Life threatening attack  ADMIT IN ICU • Severe attack persisting after initial treatment • Previous near fatal or brittle attack • Concerns about compliance • Living alone • Psychological problems • Physical disability / learning difficulty • Pregnancy • Presentation at night

  10. Hospital Treatment – Immediate action • CBC (to r/o infection) • Chest X-ray (to r/o pneumothorax) • Oxygen (40-60%) • β2 agonist –nebulised or MDI + spacer • Inhaled Ipratropium can be added if required • Systemic steroid (Prednisolone / Hydrocortisone) • Inhaled steroids to be continued or started as soon as posible • Avoid sedation

  11. Nebulised salbutamol 5 mg or 0.15 - 0.3 mg/kg salbutamol hourly (to a maximum of 10 mg per hour have been used in trials so far) Nebulised Ipratropium bromide 250-500 mcg 6 hourly

  12. Acute severe asthma…continues • Oxygen continues • Nebulised ß2-agonist(5 mg salbutamol every 20 minutes or continuously at 5-10mg/hr) • Nebulised ipratropium bromide(500 mcg 4-6 hrly ) • Combination of above two

  13. Acute severe Asthma Treatment (Contd.) • Obtain IV access • Start steroids (4 mg/kg hydrocortisone loading dose, then 100 mg 6 hrly) • Antibiotics ( not routinely ) • Adequate hydration • Still deteriorating - Start Aminophylline infusion (0.5 - 0.7 mg/kg/hr)

  14. Acute severe Asthma Treatment (Contd.) • Adrenaline (0.1 mg sc) • Cautious CPAP (ideally BiPAP) • Mechanical ventilation • 6 - 10 RR • Low TV (6 - 10 ml / kg) • I:E ratio 1:3 or longer • Maintain PaO2 > 60 mmHg • Allow PaCO2 to rise, provided pH > 7.2 • Adequate sedation and paralysis

  15. Management of acute severe Asthma in children > 2 years • High O2 concentrations • β2 agonist –nebulised or MDI + spacer • Systemic steroids ( Oral / IV ) • IV Bronchodilators ( Salbutamol 15μg/kg bolus or continuous infusion of 1-2μg/kg/min upto 5μg/kg/minin PICU)

  16. Treatment (general practice) • Oxygen (Check Room air O2 saturation if available) • Nebulised salbutamol 5 mg • Prednisolone (30-60 mg) orIV Hydrocortisone 200 mg • Nebulised Ipratropium Bromide (500 mcg) • SC Terbutaline / IV Aminophylline (5mg/kg bolus over 20 mins.) • Arrange for ambulance

  17. Emergency Department Management Acute Asthma Initial AssessmentHistory, Physical Examination, PEF or FEV1 Initial TherapyBronchodilators , O2 if needed GoodResponse Incomplete/Poor Response Respiratory Failure Add Systemic Glucocorticosteroids Observe for atleast 1 hour Good Response Poor Response If Stable,Discharge toHome Discharge Admit to Hospital Admit to ICU

  18. Instructions / points on discharge • Been on discharge medication for 24 hours • Inhaler technique checked • PEFR diurnal variability < 25% • Oral + inhaled steroids / bronchodilators • ? PEFR meter • Follow-up appointment < 48 hrs with GP

  19. ‘Treat acute severe asthma at least 4 days before it occurs’ Thomas Petty

  20. PREVENT ACUTE ATTACKS OF ASTHMA BY TAKING REGULAR INHALED CORTICOSTEROID TREATMENT

More Related