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Asthma (Examination (Differential (Pulmonary oedema: cardiac asthma,…

- - - - Inhalers
      - Peak flow meter
      - Nebuliser
  - - - Usually normal
      - May be ↓ AE and mild wheeze
- - - - Educate
        
        Liaise w/ specialist nurse
        Need for Rx compliance
        Emergency action plan
      - MDT: GP, specialist nurses, respiratory physician
      - Technique for inhaler use
      - Avoidance: allergens, smoke (ing), dust
      - Monitor: Peak flow diary (2-4x/d)
    - - No exacerbations
      - No reliever therapy: no PRN salbutamol
      - No night time waking
      - <20% diurnal variation
      - Normal lung function
  - - - GORD: dyspepsia
      - Churg-Strauss: recent onset, rash, neuropathy
  - - - PEFR
    - - FBC (eosinophila)
      - ↑IgE
      - Aspergillus serology
    - - ↓ FEV1, ↑RV
        FEV1:FVC < 0.75
        ≥15% improvement in FEV1 w/ β-agonist
- - - - PaO2 usually normal or slightly ↓
      - PaCO2 ↓
      - If PaCO2 ↑: send to ITU for ventilation
  - - - PEFR <50%
      - Can’t complete sentence in one breath
      - RR >25
      - HR >110
    - - PEFR <33%
      - SpO2 <92%, PCO2 >4.6kPa, PaO2 <8kPa
      - Cyanosis
      - Hypotension
      - Exhaustion, confusion
      - Silent chest, poor respiratory effort
      - Tachy-/brady-/arrhythmias
- - - - Write “no sedation” on drug chart
      - Hydrocortisone 100mg IV or pred 50mg PO (or both)
      - Nebulised salbutamol (5mg) and ipratropium (0.5mg)
      - 100% O2 via non-rebreathe mask (aim for 94-98%)
      - Sit-up
  - - - Load: 5mg/kg IVI over 20min
        Unless already on theophylline
      - Continue: 0.5mg/kg/hr
      - Monitor levels