asthma
had to bite the bullet and create this gargantuan document sometime. oh well.
Asthma in children
Chronic management of asthma
acute exacerbation
risk stratification
| Adults | Children | |
|---|---|---|
| Near-fatal | Raised PaCO2 and/or requiring mechanical ventilation with ↑ inflation pressures | |
| Life-threatening | symptoms: cyanosis, drowsy, exhaustion, poor respiratory effort, confusion (may be a sign of hypoxia) signs: oxygen saturation on air less than 92%; hypotension; PEF less than 33% best or predicted; and/or 'silent chest'. PaCO2 normal (4.5-6.0) |
same as adults |
| Acute severe | inability to complete sentences in one breath oxygen saturation on air less than 92%; PEF 33–50% best or predicted pulse rate more than 110 beats per minute; and respiratory rate more than 25 breaths per minute |
too breathless to talk or feed; use of accessory neck muscles oxygen saturation on air less than 92% PEF 33–50% best or predicted > HR >140 - age 2–5 years > HR >125 - age >5 years > RR >40 - age 2–5 years > RR >30 - age >5 years |
| Moderate | talking in sentences; prefers sitting to lying; not agitated; no accessory muscle use; oxygen saturation on air 92% or more; PEF more than 50% best or predicted, and no features of acute severe asthma. |
talking in sentences oxygen saturation on air 92% or more PEF more than 50% best or predicted > HR <140 - age 2–5 years > HR <125 - age >5 years > RR <40 - age 2–5 years > RR <30 - age >5 years. |
discharge guidance
- If there are signs of a moderate exacerbation, assess whether the person can be managed at home, if:
- There is a good response to initial treatment and symptoms have improved.
- PEF is improving to more than 60–80% of best or predicted.
- Oxygen saturation on air is more than 94%.
- The person is able to manage at home with appropriate support.
Corticosteroid duration
Continue oral prednisolone until recovery. Dose tapering is not needed if prednisolone is prescribed for less than 2 weeks. Advise not to stop ICS while taking oral prednisolone treatment.
- In adults and children aged 16 years and over continue for a minimum of 5 days or until recovery if longer.
- In children aged 6–15 years, continue for a minimum of 3–5 days or until recovery if longer.
- In children aged 2–5 years, continue for a minimum of 3–5 days or until recovery if longer.