⇒ ASTHMA
IN ADULTS
● Acute episodes
○ Red flags: O2 <92%, exhaustion, confusion, coma, reduced consciousness,
bradycardic/hypotensive, silent chest, cyanosis, feeble respiratory effort
○ DDx: foreign body inhalation, anaphylaxis, pneumothorax, pneumonia,
inducible laryngeal dysfunction
○ Assessment:
1. Rapid examination to check severity
2. Check DDx for acute respiratory distress
3. Start treatment
4. Complete clinical assessment with targeted Hx: symptom onset
rapidity, reliever (dose, number of doses, last dose), current asthma
meds, trigger, smoking, comorbidities
5. Assess risk of life-threatening attack: hypoxia, unable to lie flat,
previous asthma attack/hospital admission, high recent beta2 agonist
use, requiring >/= 3 classes of asthma meds
○ Mx: based on severity
■ Calm reassuring environment, sit patient upright and have under direct
visual observation
■ Anaphylaxis? → 0.5ml 1:1000 adrenaline IM, call ambulance
to transport to ED, continue adrenaline every 5 min until
ambulance arrives
■ Follow up appointment - reassess patient, identify causes of acute
episodes, prevent further episodes
,
, ● Non-acute episodes
○ Symptoms: intermittent/episodic SOB, chest tightness, dry cough, wheeze,
worse night/early morning, triggered by exercise/allergens/meds/illnesses, Hx
of atopy, symptoms improve with bronchodilator
○ Investigations: spirometry, serial peak flow, bronchial provocation test, CXR,
FBC (eosinophils)
○ DDx: inducible laryngeal obstruction, HF, obesity, GORD, anxiety, meds,
obstructive sleep apnoea, foreign body inhalation, COPD, bronchiectasis
IN ADULTS
● Acute episodes
○ Red flags: O2 <92%, exhaustion, confusion, coma, reduced consciousness,
bradycardic/hypotensive, silent chest, cyanosis, feeble respiratory effort
○ DDx: foreign body inhalation, anaphylaxis, pneumothorax, pneumonia,
inducible laryngeal dysfunction
○ Assessment:
1. Rapid examination to check severity
2. Check DDx for acute respiratory distress
3. Start treatment
4. Complete clinical assessment with targeted Hx: symptom onset
rapidity, reliever (dose, number of doses, last dose), current asthma
meds, trigger, smoking, comorbidities
5. Assess risk of life-threatening attack: hypoxia, unable to lie flat,
previous asthma attack/hospital admission, high recent beta2 agonist
use, requiring >/= 3 classes of asthma meds
○ Mx: based on severity
■ Calm reassuring environment, sit patient upright and have under direct
visual observation
■ Anaphylaxis? → 0.5ml 1:1000 adrenaline IM, call ambulance
to transport to ED, continue adrenaline every 5 min until
ambulance arrives
■ Follow up appointment - reassess patient, identify causes of acute
episodes, prevent further episodes
,
, ● Non-acute episodes
○ Symptoms: intermittent/episodic SOB, chest tightness, dry cough, wheeze,
worse night/early morning, triggered by exercise/allergens/meds/illnesses, Hx
of atopy, symptoms improve with bronchodilator
○ Investigations: spirometry, serial peak flow, bronchial provocation test, CXR,
FBC (eosinophils)
○ DDx: inducible laryngeal obstruction, HF, obesity, GORD, anxiety, meds,
obstructive sleep apnoea, foreign body inhalation, COPD, bronchiectasis
