Acute Asthma

• Onset of severe symptoms is known as an
acute exacerbation of asthma or an
asthma attack
• How do we assess severity?
– Wheeze and respiratory rate?
– Accessory muscle use?
– Pulse rate?
– Presence of pulsus paradoxus?
– Breathlessness?
– Cyanosis?

Acute Asthma Classification • Mild: <7 • Moderately severe: • Severe: >12 7 .

drowsiness • Unable to talk • Marked accessory muscle use • Cyanosis. agitation.Acute Asthma Classification Severe Life-threatening • Too breathless to talk or feed • Some accessory muscle use • RR > 50/min • Pulse > 140/min • Fatigue. silent chest or poor respiratory effort .

Acute Asthma Management • Mild – Short Acting Beta 2 Agonists (SABA) as a nebulizer (0. min 2 puffs and max 8 puffs per dose) – If do not improve  Oral systemic glucocorticoids (dexamethasone. min 2. or prednisone) .5 mg and max 5 mg per dose) or MDI ( 1/4 to 1/3 puff/kg.15 mg/kg. prednisolone.

– Systemic oral glucocorticoids soon after arrival in the emergency department (ED) or after the first inhalation therapy is initiated – IV magnesium sulfate  if there is clinical deterioration despite treatment with beta agonist. and systemic glucocorticoids . ipratropium.Acute Asthma Management • Moderate – Supplemental oxygen if oxygen saturation is ≤92% – Inhalation therapy with a SABA – Ipratropium bromide. Administer with each of the first three beta agonist nebulizer treatments or continuously OR administer with the second and third treatments.

epinephrine) for children with poor respiratory flow. IV terbutaline . suboptimal response – Ipratropium bromide – IV systemic glucocorticoids • If good response  procede as moderate • Poor response  IV magnesium sulfate. uncooperative.Acute Asthma Management • Severe – Supplemental O2 if saturation ≤92% – Nebulized SABA OR SC/IM beta-agonist (terbutaline.

Acute Asthma – Hospital Admission • Criteria for hospital admission: – Little improvement to Beta agonists and systemic corticosteroids – Beta agonist therapy required more often than 4 hours – O2 Saturation < 92% – History of life-threatening asthma – Lack of health facilities – Poor outpatient compliance .

O2 and magnesium sulfate – Ipratropium bromide discontinued – Monitor patient ( every 15 minutes to 4 hours) – Consult asthma specialist – Patient Education – Failure to respond  ICU – Symptoms regress  discharge . systemic corticosteroids.Acute Asthma – Hospital Admission • Management – Continue Beta-blockers.

au/clinicalguide/ guideline_index/Asthma_Acute/ .References • http://www.uptodate.com/contents/ acute-asthma-exacerbations-in-chi ldren-emergency-department-manage ment#H14 • http://www.uptodate.org.com/contents/ac ute-asthma-exacerbations-in-childre n-inpatient-management?source=see_l ink • http://www.rch.