Table of Contents
Include in assessment
- History: baseline and severity, exacerbation history, ICU admissions, normal PEFR (if asthmatic), infective symptoms, inhaler compliance, home oxygen/nebs
- PEFR regularly (in asthma)
- Investigations:
- ABG (should suggest hyperventilation asthma; if hypoxaemic/hypercapnic, patient is tiring)
- CXR (exclude pneumothorax)
- Bloods (including regular potassium monitoring)
Classifying asthma severity
- Life-threatening (PEFR <33%): 33, 92 CHASE
- 33: PEFR <33% predicted
- 92: Sats <92%
- Cyanosis
- Hypotension
- Arrhythmia
- Silent chest
- Exhaustion
- Severe (PEFR <50%): cannot complete sentences, respiratory rate > 25, heart rate >110
- Moderate (PEFR <75%)
- Mild (PEFR >75%)
Treating asthma exacerbation: O SHIT ME!
Reference: BTS/SIGN ‘Guideline for the management of asthma’ 2019
Treating COPD exacerbation
- O SHIT as in asthma but prednisolone dose is 30mg OD and give controlled oxygen, i.e. 24-28% (venturi mask), and do regular ABGs to determine further oxygen therapy (see prescribing notes on oxygen therapy)
- Antibiotics: prescribe if any signs of infection as per local guidelines, e.g. doxycycline
- Chest physiotherapy
- Consider BiPAP in hypercapnic respiratory acidosis not responding to medical management (or if you achieve oxygen sats of 88-92%/PaO2 ≥8 without a hypercapnic respiratory acidosis despite medical management)
If hypoxaemia/hypercapnia is worsening despite maximal therapy, involve senior/anaesthetist with a view to intubation and ventilation.
Intensive care indications
- Requiring ventilator support
- Worsening hypoxaemia / hypercapnia / acidosis
- Exhaustion
- Drowsiness / confusion
Try some questions
What is procalcitonin and how could this help in management?
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How are nebulisers best administered?
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What are the adverse effects of back-to-back salbutamol nebulisers?
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