Download presentation
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;
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 mg/kg salbutamol hourly (to a maximum of 10 mg per hour have been used in trials so far) Nebulised Ipratropium bromide 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 ( mg/kg/hr)
14
Acute severe Asthma Treatment (Contd.) Adrenaline (0.1 mg sc)
Cautious CPAP (ideally BiPAP) Mechanical ventilation RR Low TV ( 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/min in PICU)
16
Treatment (general practice)
Oxygen (Check Room air O2 saturation if available) Nebulised salbutamol 5 mg Prednisolone (30-60 mg) or IV Hydrocortisone 200 mg Nebulised Ipratropium Bromide (500 mcg) SC Terbutaline / IV Aminophylline (5mg/kg bolus over 20 mins.) Arrange for ambulance
17
Acute Asthma Emergency Department Management
Initial Assessment History, Physical Examination, PEF or FEV1 Initial Therapy Bronchodilators , O2 if needed Good Response Incomplete/Poor Response Respiratory Failure Add Systemic Glucocorticosteroids Observe for at least 1 hour Good Response Poor Response If Stable, Discharge to Home 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
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.