^

Health

A
A
A

Acute severe asthma

 
, medical expert
Last reviewed: 23.04.2024
 
Fact-checked
х

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.

If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.

Acute severe asthma is a severe bronchospasm in a patient with a history of asthma.

trusted-source[1], [2], [3], [4], [5], [6],

What causes acute asthma?

  • Asthma in history with emergency hospitalizations in the past.
  • Respiratory tract infections.
  • Trigger factors, such as stress, cold, exercise, smoking, allergen.
  • Premature or newborns with low weight.

What are the symptoms of acute asthma?

Acute severe asthma is clinically expressed by the following symptoms:

  • Peak expiratory flow rate (PEFR) <33-50% of the best or predicted, SpO2 <9 2%, PSE 120 bpm (<5 years) or> 130 bpm (2-5 years), BHC> 30 V min (> 5 years) or> 50 per min (2-5 years), the involvement of ancillary muscles in the act of breathing.

Life-threatening asthma: Any of the following in a patient with acute severe asthma:

  • PEFR <33% of the best or predicted, SpO2 <92% or PaO2 <8 kPa (60 mmHg), normal RaCO2 (4.6-6 kPa, 35-45 mmHg), hypotension, exhaustion , confused consciousness or coma, dumb zones of pulmonary fields, cyanosis, easing of respiratory effort.

Almost fatal asthma:

  • increased RACO2 and / or the need for mechanical ventilation
  • Confused consciousness or drowsiness, maximal involvement of auxiliary muscles in the act of breathing, exhaustion, SpO2 <92% in air, CHSR 140 bpm, inability to speak.

How is acute asthma diagnosed?

  • SpO2, PEFR or FEV1 (> 5 years).
  • If the condition is critical: blood gases, chest X-ray, the level of theophylline in the plasma.

Differential diagnosis

The wheezing in the lungs can be of a different origin:

  • bronchiolitis or croup; o Aspiration of a foreign body - asymmetry in auscultation;
  • epiglottitis - after introduction into practice of the vaccine against Haemophilus influenzae B is very rare;
  • pneumonia - can be both the primary cause of wheezing, and the trigger of an asthma attack;
  • tracheomapacia.

trusted-source[7], [8], [9], [10]

Immediate Action

Acute severe asthma:

  • salbutamol 10 injections through the dispenser and adapter ± face mask or salbutamol inhaler (2.5-5 mg);
  • prednisolone orally 20 mg (2-5 years), 30-40 mg (> 5 years) or hydrocortisone intravenously 4 mg / kg;
  • Salbutamol should be repeated every 30 minutes, add ipratroprium bromide 250 μg with an inhaler every 20-30 minutes.

Life-threatening asthma:

  • immediately salbutamol inhaler 2.5-5 mg;
  • ipratropriuma bromide inhaler 250 mcg;
  • hydrocortisone intravenously 4 mg / kg;
  • bronchodilators every 20-30 minutes;
  • epinephrine, sc / 10mkg / kg (solution 0.01 ml / kg 1: 1000, or 0.1 ml / kg 1:10 000).

Further management

  • When improving - monitor SpO2, inhale prednisolone orally every 3-4 hours, for 3 days, transfer to a specialized department.
  • If, despite the treatment, the condition worsens:
    • intravenously salbutamol, titrating by effect, up to 15 mcg / kg for 10 min, then infusion 1-5 mcg / kg / min;
    • aminophylline: loading dose 5 mg / kg, then intravenously infusion 1 mg / kg / h;
    • continue inhaling every 20 minutes;
    • think about the use of adrenaline (0, O2-0.1 mcg / kg / min);
    • magnesia sulfate intravenously 40 mg / kg (maximum 2 g).
  • If respiratory failure increases: intubate, ventilate and transfer to a pediatric ICU.

Special Considerations

  • In severe asthma with very high pressure in the airways, a decrease in the respiratory volume and irregular capnography curve, ventilation may be difficult.
  • Manual ventilation with a low-stretch system may be required, but monitoring airway pressure, and especially inhalation pressure, will be extremely important. Pressure in the airways up to 30-40 cm H20 may be required. Increased pressure indicates the need for the most active use of bronchodilators.
  • All inhalation anesthetics cause bronchial relaxation and can be useful in severe attacks. It is necessary to monitor the discharge of the used gas mixture.
  • These children are usually dehydrated, and therefore the induction of anesthesia for intubation should be preceded by infusion preparation with crystalloids of 20 ml / kg. Slow administration of the preparations is preferable, but fast non-fasting patients may require rapid sequential induction. Propofol and ketamine are ideal.
  • Peak expiratory flow rate in children: this is a simple method of measuring airway obstruction, which allows to determine the average or high severity of the disease. The measurement is carried out using a standard Wright peak meter.

You are reporting a typo in the following text:
Simply click the "Send typo report" button to complete the report. You can also include a comment.