Emergency Medicine | Management of Acute Exacerbation of Asthma in Adults | Dr. Pramendra Gupta

A video by:
Dr. Bharat KC (MBBS 2014, BPKIHS)

Acute Exacerbations of Asthma in Adults: Emergency Department Management
Dr. Pramendra Prasad Gupta
Associate Professor
Department of General Practice and Emergency Medicine
B.P. Koirala Institute of Health Sciences

The best strategy for management of acute exacerbations of asthma is early recognition and Intervention; before attacks become severe and potentially life threatening.

ADVICE RELATED TO COVID-19 PANDEMIC
Asthma does not appear to be a strong risk factor for acquiring Corona virus disease 2019, although poorly controlled asthma may lead to a more complicated disease course for those with COVID-19. Every effort should be made to avoid exposure to the SARS-CoV-2 virus and all regular medications necessary to maintain asthma control should be continued during this pandemic.

Asthma is a chronic inflammatory disorder of the lungs that is associated with airway hyperresponsiveness that leads to
recurrent episodes of wheezing
shortness of breath
chest tightness
and coughing.

Asthma is a chronic inflammatory disorder of the lungs that is associated with airway hyperresponsiveness that leads to
recurrent episodes of wheezing
shortness of breath
chest tightness
and coughing.

Signs of Severe Exacerbations
Tachypnea : more than 30 breaths/min
Tachycardia : more than 120 beats/min
Use of accessory muscles of inspiration (Sternocledomastoid muscle)
Diaphoresis
Inability to speak in full sentence or phrases
Inability to lie supine due to breathlessness
Pulse paradoxus (fall in systolic blood pressure by atleast 12 mmHg during Inspiration

Features suggesting an alternate or comorbid condition

Fever
Purulent sputum production
Urticaria
Pleuritic Chest Pain raise the possibility of
alternate diagnosis such as


Pneumonia, flare of bronchiectasis, anaphylaxis, pneumothorax

Peak Flow Measurement
Best method for objecting assessment of the severity of an asthma attack in patients who are able to perform testing.
Patients with signs of impending respiratory failure should not be asked to perform this testing.
A peak flow rate below 200 L/min indicates severe obstruction. In terms of percent of predicted less than 50 %.
Considered moderate when the PEF more than 50 but lless than 70 percent and does not reverse to normal after bronchodilator therapy.

Oxygenation
Use of transcutaneous pulse oximetry monitoring particularly among patients who are in distress, have a forced expiratory volume in one second (FEV1) or PEF less than 50 percent of baseline.

Hypercapnia
PEF more than 45 mmHg
if ABG is not available.
Progressive hypercapnia during an exacerbation of asthma is generally an indication for mechanical ventilation.

Chest Radiograph
Chest radiographs are generally unrevealing in acute asthma attacks and are not routinely in the urgent care setting.
However, a chest radiograph should be obtained when a complicating cardiopulmonary process is suspected (Fever, unexplained chest pain, leukocytosis, or hypoxemia), when a patient requires hospitalization, and when diagnosis is uncertain

Management
Primary goals of therapy for acute severe asthma are the rapid reversal of airflow limitation and the correction, if necessary, of hypercapnia or hypoxemia.

Oxygen
Supplimental oxygen SPO2 less than 90 percent.
If continuous oxygen saturation monitoring is not available.

INHALED BETA AGONIST
Short Acting Beta 2 Selective adrenergic agonists (SABA)
The standard therapy for initial care in the emergency department is inhaled Salbutamol.
Typically three treatments are administered within the first hour.

1. Standard Nebulization
Asthalin 2.5 to 5 mg by jet nebulization every 20 min for three doses, then 2.5 mg to 5 mg every one to four hours as needed.
2. Metered Dose Inhaler (MDI)
With spacer 4 to 8 puffs every 20 min for 1st Hour. (upto 10 puffs).
3. Continous nebulization
Delivering one nebulizer treatment immediately after the other without pause between treatments.
10-15 mg over one hour (in intensive care unit)

Nebulizer Vs MDI
The relatively large particle size generated by jet nebulizers and the loss of medication from the expiratory port of many nebulizer systems make this method of delivery relatively inefficient compared with a MDI.

Comparison of MDI plus Spacer with MDI have demonstrated the same beta agonist in reduced doses when given vis MDI with Spacer.

Music credit:
Aakash Gandhi - lifting dreams

@DIP -Medical Videos | 2020
#bronchialasthma #emergencymedicine #bpkihs

[CROWNERSQUAD]

Excellent presentation. I'm an intern doc from BANGLADESH. This lectute helped me a lot. Thanks

[advtomk]

Thanks for the really informative advise.

[drnarendra]

Nice Vedio Dr Bharat bro.Best of luck.

[venkateshgandhi]

Was listening in headphones & at exactly 8:06 i thought one of my headphones is damaged

[AP_Pratheepan]

Not informative though. Can you do a video explaining everything about asthma in acute settings.