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Medspresso #Episode 51: Asthma
Dr Swapnil Pawar
Asthma
Written by Dr Andrew Lam
Classification of Asthma Severity
| Mild/Moderate | Severe | Life Threatening | |
| O2 Saturations | >94% | 90-94% | <90% |
| Auscultation | Wheeze | May be similar to mild/moderate | Silent chest |
| Speech | Can finish a sentence | Phrases | Single words |
| Respiratory Distress | Minimal | Some use of accessory muscles | Severe respiratory effort |
| Level of Consciousness | Alert | May be similar to mild/moderate | Drowsy |
Acute Management of Asthma
Mild/Moderate
PRN Salbutamol (4-12 puffs) as required
Severe/Life Threatening
- Salbutamol 5mg Nebulised (or 12 puffs) q20mins
PLUS
- Ipratroprium 500mcg Nebulised (or 8 puffs) q20 mins
Continue this for the first hour. If therapy ineffective:
- 10 mmol MgSO4 infused over 20 minutes
And consider further salvage therapy:
- IV Adrenaline infusion
- IV Ketamine infusion
- IV Aminophylline
Also give Hydrocortisone 100mg QID IV for prevention of secondary reaction and bronchospasm
Prevention of Asthma
Prevention of asthma flares occurs in a step-wise approach:
Step 1 – PRN SABA
Step 2 – Low dose ICS + PRN SABA
Step 3 – Low dose ICS + LABA + PRN SABA
Step 4 – Medium dose ICS + LABA + PRN SABA. Alternatively low dose ICS + LABA + LAMA
Past this, referral to a respiratory physician is often warranted.
SABA – short acting beta agonist, ICS – inhaled corticosteroid, LABA – Long acting beta agonist, LAMA – Long acting muscarinic antagonist
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