Asthma Attack

This is an acute episode of worsening asthma. It presents with:

• Progressively worsening SOB

• Chest tightness

• Expiratory wheeze

• Tachypnoea

• Respiratory distress - Use of accessory muscles

Differentials of it include:

• Acute exacerbation of COPD (AECOPD)

• Pulmonary oedema

• PE

• URT obstruction

• Anaphylaxis

Severity of Attack

ABG

This will initially show a respiratory alkalosis due to the patient blowing off a lot of CO2 quickly. It's important to do repeat ABGs in these patients as a raise in CO2 and subsequent shift to respiratory acidosis indicates that the patient is getting tired and losing respiratory effort.

Management

Immediate things to do:

• 100% O2 via NRM

• Nebulised Salbutamol and Ipratropium

• IV Hydrocortisone/Oral Prednisolone

If the patient is having a life-threatening attack:

• IV Magnesium sulphate over 20 minutes

• Nebulised salbutamol every 15min

• Inform the intensive care team

If no improvement:

• Consider Aminophylline unless already on theophylline

• Early admission to ITU (can become very hard to intubate with severe bronchoconstriction)

Monitor patients with multiple PEF measurements, SpO2, ABG, Chest auscultation

N.B. Nebulisers send the medication straight into the lungs, therefore requiring little respiratory effort from the patient.

Discharge

All patients should be given a:

• Asthma action plan - clear plan of everything they need to know about their asthma

• Rescue pack - medications to use in case of another attack