Management of Acute Severe Asthma

·      Definition:-

Acute Severe Asthma is defined as episodes of progressive increase in shortness of breath, cough and wheezing.

    ·      Aetiology:-

1.    Viral infection 

2.    Allergen exposure

3.    Environmental pollutants 

4.    Occupational irritants/ sensitizers 

5.    Smoking 

6.    Medicine – Aspirin

      ·      Clinical Features:

Any of the following – 

1.    Peak Expiratory Flow (PEF)  33-55% of predicted 

2.    Respiratory Rate    >25/min 

3.    Heart rate  >110 bpm 

4.    Inability to complete a sentence in one breath

·      Features of Life-threatening asthma:- 

Any one of the following- 

1.      PEF <33% of predicted 

2.      Bradycardia 

3.      SpO₂ <92% 

4.      Cyanosis 

5.    ↑  pCO₂ 

6.      Hypotension 

7.      Confusion 

8.      Silent Chest

·      Management:- 

Ø Aim of Management: 

1.    Correction of Hypoxemia 

2.    Rapid reversion of airflow obstruction 

3.↓ likelihood of recurrence

 

Ø Diagnostic Workup: 

1.    Complete blood count (CBC) 

2.    Renal Function Test 

3.    Liver Function Test 

4.    Na, K, Ca, Mg levels in Serum 

5.    Blood Glucose 

6.    Arterial Blood Gas (ABG)

 

Ø Management Proper:

1.    O₂  via facemask or nasal prongs  - to maintain SpO₂ >90%

2.    Nebulization with Short Acting Beta Agonist 2.5 – 5 mg  +  Ipratropium Bromide 0.5 mg in 3-5 mL of Normal Saline (NS) to be repeated every 15- 20 minutes for the first hour

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                                                                                                                                                                                                 Then according to response for 4- 6 hours

3.    Nebulization with Ipratropium Bromide 0.5 mg to be added 4- 6 hourly

4.    Systemic steroids-  i.v Hydrocortisone 200 mg stat                                                            followed by 100 mg QDS

                                                  Or

                              Oral Prednisolone 40 mg daily

5.    If no adequate response occurs-  i.v MgSO₄  1- 2 g over 30 minutes

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