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7 Cards in this Set
- Front
- Back
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What are the characteristic features of asthma? |
• Paroxysmal and reversible (responds to treatment) obstruction of the airways. • It involves bronchospasm and mucous hypersecretion • IgE mediated atopy, associated with eczema, hayfever, and allergies |
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What are some interval symptoms of asthma? |
Symptoms that occur in-between acute exacerbations: • Nocturnal cough • SOB with exercise / in cold • Intermittent dyspnoea |
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What abnormal finding might you expect to see on the chest of patient that has had chronic severe asthma as a child? |
Harrison sulci |
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How is the severity of asthma determined? |
Mild: • Audible wheeze • O2 sats >92% • PEF >50% predicted or best value • None of the symptoms of severe asthma Severe: • Too breathless to talk or feed • Use of accessory neck muscles • O2 sats <92% • Resp rate >50 (aged 2-5) or >30 (age 5+) • Pulse >130 (aged 2-5) or >120 (age 5+) • PEF <50% predicted or best Life threatening: • Silent chest • Poor respiratory effort / exhaustion • Altered consciousness / confusion • Cyanosis • O2 sats <92% • PEF <33% predicted or best (may be unable to do PEF) • Bradycardic |
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How is an acute exacerbation of asthma managed? |
Severe: • IV hydrocortisone or oral prednisolone • SABA 10 puffs via spacer or nebulised • Nebulised ipratropium bromide if poor response • Repeat SABA every 20-30 mins Life threatening: • Nebulised SABA + Ipratropium bromide • IV hydrocortisone • IV aminophyline ± magnesium sulphate or IV salbutamol ± magnesium sulphate |
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What is the maintenance treatment plan (step wise) for asthma in children? |
Step 1: • Short acting B2 agonist eg salbutamol • Infants and young children - consider ipratropium bromide (atrovent) Step 2: • Add inhadeled corticosteroid (beclomethasone) • <5 years consider leukotriene receptor antagonist Step 3: • >5 years old - Add LABA: - Good control = continue - Some benefit = move to step 4 - No benefit = stop LABA and try leukotriene receptor antagonist or theophyline • Under 5: consider adding leukotriene recptor antagonists to steroids, refer to respiratory paediatrician Step 4: • Increase daily inhaled corticosteroid dose, refer to resp. paediatrician, consider adding 4th drug Step 5: • Daily oral steroids |
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What 4 questions should you ask to try and gauge someones asthma control? |
• How often (per day / per week) do you have to use your blue inhaler? • How many times in the last week / month have you been breathless • Are you having symptoms at night or being woken at night? • Has your asthma prevented you from doing something that you would otherwise normally do? |
