Assessment
A sudden onset of wheeze after insect sting or food/medication ingestion could indicate what?
Anaphylaxis - always assess for other signs/symptoms
What is the first-line bronchodilator used to treat an acute asthma exacerbation?
Salbutamol
Name thew 3 main pathological processes that narrow the airways in asthma
Bronchoconstriction
Airway inflammation
Mucus production
What is the preferred method of giving salbutamol in most mild/moderate/severe asthma?
pDMI with spacer
- URTI/ viral illness
- Passive smoking
- Exercise
- Cold air
- Allergens
Name 3 signs of increased WOB in a child with asthma
Intercostal recession
Subcostal recession
Tracheal tug
Nasal flaring
Accessory muscle use
Head bobbing (infants)
Tachypnoea
What class of medication is salbutamol?
Short-acting β₂ agonist
What causes a wheeze?
Air moving through narrowed airways causes turbulent airflow, producing a wheeze
When should supplemental oxygen be administered?
When sats <90% or below the child's target range
If unsure if a child is presenting with asthma or anaphylaxis, which should you treat first?
Anaphylaxis - however, treatment of both are time critical
What features indicate a severe asthma exacerbation? (4)
Markedly/severe increased WOB
Increased RR
Agitated
Pale
How do corticosteroids help in an asthma exacerbation?
Reduce airway inflammation/ oedema, decrease mucus production
Why does prolonged expiration occur in asthma?
Narrowed airways make it difficult to expel air, causing air trapping
What is the dosing of ipratropium for children 1-5 years old with signs of a severe asthma presentation?
4 puffs via MDI every 20 minutes for 3 doses
How often should you re-assess a child's WOB when they are receiving burst therapy?
20 minutely - should be re-assessing before giving next doses of salbutamol +/- ipratropium
Should you be worried about a child that looks unwell, but has a silent chest? Why?
YES! This may indicate impending respiratory collapse
Explain how ipratropium assists in severe asthma
- Anticholinergic
- Blocks muscarinic receptors
- Prevents bronchoconstriction
- Reduces mucus production
In a child <12 months, what is the condition that is usually diagnosed when there is a wheeze present, often caused by viral infection affecting the small airways?
Bronchiolitis
Name a second-line treatment in severe asthma
IV Aminophylline
Why can a child with asthma develop a “barrel chest” or hyperinflation during a severe attack?
Air becomes trapped behind narrowed airways because expiration is impaired
A child presents with:
What severity are they classified as?
Life - threatening
What electrolyte abnormality can occur with frequent salbutamol use?
Hypokalaemia
What cells are responsible for releasing inflammatory mediators such as histamine and leukotrienes during an asthma flare?
Mast cells
a 7 year old child presents with a severe asthma exacerbation, what are the first 3 key managements steps?
- ABCDE
- Give O2 if required (aiming >90%)
- Administer bronchodilators/ ipratropium and give corticosteroids early
Why can salbutamol cause tachycardia and tremor?
β₂ stimulation can have some systemic effects, including cardiac stimulation and skeletal muscle effect