power point presentation on asthma

Managing Acute Asthma Exacerbations

Apr 05, 2019

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Managing Acute Asthma Exacerbations. Cathryn Caton, MD, MS. Objectives. Review assessment of patients with asthma exacerbation Review components of brief history and physical exam Describe findings associated with mild, moderate and severe exacerbations

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• mild exacerbation
• patient education
• asthma exacerbation
• acute asthma exacerbations
• respiratory arrest imminent

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Managing Acute Asthma Exacerbations Cathryn Caton, MD, MS

Objectives • Review assessment of patients with asthma exacerbation • Review components of brief history and physical exam • Describe findings associated with mild, moderate and severe exacerbations • Treatment of moderate and severe exacerbations • Review discharge planning for patients with an asthma exacerbation

Assessment of Asthma Exacerbation • In ER – evaluate and triage patients immediately • Start treating immediately • Obtain brief, focused history • Focused physical examination • Once initial treatment is completed, then do detailed history and physical exam

Brief History • Time of onset and potential causes of current exacerbations • Severity of symptoms compared with previous exacerbations • Current medications and time of last dose (asthma medications) • Estimation of number of times care sought for asthma related issues • Any prior episodes of LOC or intubation, and mechanical ventilation • Other potentially complicating illness – lung or cardiac; others that may be aggravated by systemic steroids

Brief Physical Exam • Assess severity of asthma exacerbation • Assess overall patient status – level of alertness, fluid status, presence of cyanosis, respiratory distress and wheezing • Identify possible complications – pneumonia or pneumothorax • Evaluate for upper airway obstruction • Don’t wait on labs to start therapy

Assessing severity of symptoms • Mild exacerbation • Moderate exacerbation • Severe exacerbation

Mild Exacerbation • Breathlessness while walking • Able to lie down • Talks in complete sentences • May be agitated • Increased respiratory rate • No accessory muscle use • Moderate wheezing, often only end expiratory • Pulse <100 • Peak flow 50-80% of predicted / personal best

Moderate Exacerbation • Breathlessness while talking • Prefers sitting • Talks in phrases • Usually agitated • Increased respiratory rate • Commonly uses accessory muscles • Loud wheezes throughout exhalation • Pulse 100-120

Severe Exacerbation • Breathlessness at rest • Sits upright • Talks in words • Usually agitated • Respiratory rate often >30/min • Usually uses accessory muscles • Wheezes usually loud throughout inhalation and exhalation • Pulse >120 • Peak flow <50% predicted / personal best

Respiratory Arrest Imminent • Drowsy or confused • Paradoxical thoracoabdominal movement • Absence of wheeze • Bradycardia

Treatment of Moderate Exacerbation • Inhaled Beta2 – agonists • Supplemental O2 to keep sats >90% • Oral systemic if no immediate response • Monitor for improvement in peak flow • Continue treatment for 1-3 hours as long as patients are showing signs of improvement • If peak flow >70% and response is sustained 60 mins after last treatment then D/C patient home

Treatment of Severe Exacerbation • Inhaled short acting Beta2–agonist + inhaled anticholinergic administered hourly or continuous • Supplemental oxygen • Systemic steroids • If Peak flow > 50% but < 70% patient should be admitted • Continue steroids either oral or IV • Monitor for improvement in peak flow

Treatment of Severe Exacerbation • Inhaled short acting Beta2–agonist + inhaled anticholinergic administered hourly or continuous • Supplemental oxygen • Systemic steroids • If peak flow remains less than 50%; drowsiness, confusion then admit to ICU • IV steroids • Possible intubation and mechanical ventilation • Consider use of magnesium sulfate and heliox-driven albuterol neb

When is it safe to discharge? • Significant improvement in symptoms • Significant improvement in peak flow – should be at least 70% of predicted / personal best

Discharge • Continue treatment with inhaled Beta2-agonist • Continue course of oral systemic steroid • Patient education • Review medication use • Review / initiate action plan • Recommend close medical follow up

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