Asthma
“more people have had an asthma diagnosis than have been diagnosed with all other lung diseases combined.”
Take away points
Take away points
We should endevour to perform a peak flow on our patients where clinically appropriate. Don’t just ignore it, as it is an important aspect of assessing the patient’s severity, however, it may not be appropriate to attempt this on those at the more severe end of the spectrum.
we may need to do a disjointed asessment with concurrent activity.
we need to risk stratify our patients if we’re considering discharge, just because symptoms have mostly resolved doesn’t necessarily mean they are safe for discharge. We know patients with previous intensive care stays, regular admissions, poor compliance with preventative meds and a recent increase in reliance of salbutamol inhalers are all riskfactors for mortality. We need to ensure that we elucidate this in our history.
All patients we’ve seen for an asthma exacerbation should be referred for a short course of steroids, either through a TTO PGD in our trusts, or through referral to a prescriber.
If they’re unwell and going into hospital, then we can give them a 100mg dose of Hydrocordisone. Just don’t forget to push this slowly, otherwise you can cause the patient to experience a burning sensation from the phosphates in hydrocortisone preservatives.
Salbutamol and ipratropium bromide nebulisers are the obvjous treatments and salbutamol nebulisers can be given back to back if needed.
Don’t forget about IM adrenaline, in lifethreatening situations, but be aware, this isnt in all guidelines, so you may be questioned about this.
Finally, in cardiac arrest situations its useful to intubate the patient. If this isnt in your scope of practice, put in an early call for enhanced care support.