Topic: Bronchial asthma
Question:Write a short note on management of acute attack of bronchial asthma. Explain with the help of a flow chart.
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The management of an acute asthma attack involves:
1. Removal of triggers: Remove any environmental triggers that may have precipitated the attack, e.g. smoke, allergens, pollutants.
2. Oxygen therapy: Provide supplemental oxygen to maintain SpO2 >94%. This helps correct hypoxemia and reduces work of breathing.
3. Bronchodilators: Administer bronchodilators to open airways, improve airflow and decrease resistance:- Short-acting beta2-agonists (e.g. salbutamol): 2-6 puffs of MDI (100-200mcg/puff) or 2.5-5mg of nebulized solution every 20 minutes for first hour.- Anticholinergics (e.g. ipratropium): 2-3 puffs MDI (20mcg/puff) or 0.5mg nebulized, along with beta2-agonists.
4. Corticosteroids: For moderate/severe attacks, oral prednisone (40-50mg) or IV hydrocortisone (200mg) help reduce airway inflammation. Repeat corticosteroids in 1-2 weeks if symptoms worsen.
5. Consider adjunct therapies:
– For life-threatening attacks (SpO2 <92% or PEF <50% of predicted): IV magnesium sulfate, IV beta2-agonists
– Theophylline for refractory symptoms: IV dose of 5mg/kg over 20-30 mins, then 0.5-0.7mg/kg/hr infusion.
– Heliox: Helium-oxygen mixture (70:30 or 80:20) to decrease density, improve airflow.
– IV aminophylline: Only if theophylline level is low or unknown. 5mg/kg load over 20-30 mins, then 0.5-0.7mg/kg/hr.
6. Admit to hospital: For persistent or worsening hypoxemia/hypercapnia, exhaustion, inability to tolerate feeds/fluids or if wheezing/symptoms not resolving despite intensive therapy. Admit to ICU if on maximal medical therapy +/- intubation.
7. Prevent relapse: Review medications, inhaler techniques and triggers/allergy management before discharge. Asthma action plan, regular medical follow-up and self-monitoring help minimize future acute severe episodes.The stepwise management of an acute asthma exacerbation aims to relieve airway obstruction and inflammation, correct hypoxemia, prevent complications and avoid hospitalization. The flow chart below outlines the structured approach to assessment and treatment of asthma attacks:Removal of Trigger/precipitant Supplemental O2 to maintain SpO2 >94%
Mild Moderate Severe
SABA (salbutamol) 2-6p + + +
SABA (ipratropium) 2p – + +
Oral steroids (prednisone) – + +
IV steroids (hydrocortisone) – – +
IV magnesium/aminophylline – – +
Heliox/IV beta2-agonists – – +
Admit to hospital – – +
Admit to ICU – – +
Monitor response to therapy
Reassess medications/ inhaler technique
Provide asthma action plan
Arrange close medical follow up
