Term
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Definition
acute state of extreme airway narrowing that is poorly responsive to usual bronchodilator therapy;
caused by uncontrolled inflammation, airway edema, excessive accumulation of mucus, & severe bronchospasm |
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Term
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Definition
rapid onset of symptoms which usually resolves rapidly with bronchodilator therapy;
caused by infiltration of neutrophils |
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Term
| Symptoms of Acute Severe Asthma |
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Definition
acute distress;
severe dyspnea;
chest tightness;
chest "burning" |
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Term
| Signs of Acute Severe Asthma |
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Definition
inspiratory & expiratory wheezing;
dry hacking cough;
tachypnea;
tachycardia;
pale or cyanotic skin;
hyperinflated chest;
hypoxic seizures; |
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Term
| Lab Info indicating Acute Severe Asthma |
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Definition
PEF and/or FEV1 <50% of personal best;
Decreased PaO2 (normal: 80-100 mmHg) and O2 saturations (normal: 93-100%, <90% on room air is severe);
May see decrease in K, Mg, increase in glucose with beta2-agonist & corticosteroid use |
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Term
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Definition
S&Sx: dyspnea only w/ activity;
PEF >= 70% of predicted;
Clinical Course:
- care for at home usually;
- prompt relief w/ SABA;
possible short course of oral systemic corticosteroids; |
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Term
| Moderate Asthma Exacerbation |
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Definition
S&Sx: Dyspnea interferes w/ or limits usual activity;
PEF 40-69% of predicted;
Clinical Course:
- usually requires office or ED visit;
- relief from frequent inhaled SABA;
- oral systemic corticosteroids: some sx last for 1-2 days after tx is begun; |
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Term
| Severe Asthma Exacerbation |
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Definition
S&Sx: dyspnea at rest, interferes w/ conversation;
PEF <40% of predicted;
Clinical Course:
- usually requires ED visit & likely hospitalization;
- partial relief from frequent inhaled SABA;
- oral systemic corticosteroids: some sx last for >3 days after tx is begun;
- adjunctive therapies are helpful; |
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Term
| Life-threatening Asthma Exacerbation |
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Definition
S&Sx: too dyspneic to speak, perspiring;
PEF <25% of predicted;
Clinical Course:
- requires ED/hospitalization, possible ICU;
- minimal or NO relief from freq. ihaled SABA;
- IV corticosteroids;
- adjunctive therapies are helpful |
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Term
| Risk Factors for Fatal Asthma Exacerbations |
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Definition
asthma history;
social history;
comorbidities; |
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Term
| Goals of Treatment for Acute Asthma Exacerbation |
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Definition
Correction of significant hypoxemia;
Rapid reversal of airflow obstruction;
Reduction in liklihood of relapse of exacerbation;
Development of a written asthma action plan; |
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Term
| Reasons for Home Management of Acute Exacerbations |
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Definition
avoid treatment delays;
prevent exacerbations;
add to pt's sense of control; |
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Term
| Initial Tx at Home in Management of Acute Exacerbation |
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Definition
| Inhaled SABA: up to 2 tx 20 min apart of 2-6 pfs by MDI or nebulizer; |
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Term
| Good Response to Initial Tx at Home |
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Definition
No wheezing or dyspnea;
PEF >=80% predicted;
Contact clinician for followup instructions & further management;
Many continue inhaled SABA every 3-4 hrs for 24-48 hrs;
Consider short course of oral systemic corticosteroids; |
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Term
| Incomplete Response to Initial Treatment of Acute Asthma Exacerbation at HOme |
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Definition
Persistent wheezing & dyspnea;
PEF 50-79% predicted best;
Add oral systemic corticosteroid;
Continue inhaled SABA;
Contact clinician urgently for further instruction; |
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Term
| Poor Response to Initial Treatment at Home for Acute Asthma Exacerbations |
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Definition
Marked wheezing & dyspnea;
PEF<50% predicted best;
Add oral systemic corticosteroid;
Repeat inhaled SABA immediately;
If distress is severe & nonresponsive to initial tx: Call you doctor AND PROCEED TO ED, consider calling 911 |
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Term
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Definition
administer via nasal cannula or mask to maintain SaO2 >90%;
Maintain SaO2 >95% in pregnant women & pts w/ heart dx |
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Term
| Short-Acting Beta-2-Agonists |
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Definition
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Term
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Definition
In the ED: addition to SABA therapy IS RECOMMENDED;
In the HOSPITAL: NOT RECOMMENDED |
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Term
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Definition
Recommended for pts who do not respond completely to initial SABA therapy;
IV therapy offers NO therapeutic advantage over PO therapy |
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Term
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Definition
| use if infection is present |
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Term
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Definition
increased respiratory rate & decreased oral fluid intake --> dehydration;
Goal: Acchieve NORMAL hydration;
Aggressive hydration is NOT RECOMMENDED;
PO is preferred, but IV is ok if necessary |
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Term
| For severe exacerbations unresponsive to initial treatments |
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Definition
SC epinephrine;
IV magnesium sulfate;
heliox;
ketamine; |
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Term
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Definition
Medications:
- may need to continue oral corticosteroids at home for 3-10 days;
- consider initiating ICS at discharge;
Education:
- inhaler technique, peak flow monitoring, causes of exacerbations, written action plan;
Follow-up Appt in 1-4 wks |
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