A 25 year old man presents to emerge with dyspnea and wheezing on exam. He states that last week he developed a “cold.” He has a 10-year history of asthma. Last year he was admitted to hospital three times for asthma exacerbations, with one ICU admission. He has a personal and family history of atopy.
- What information in this patient’s history make you concerned for a severe asthma exacerbation?
The following information on history are red flags for a severe asthma exacerbation:- Several admissions to hospital for asthma exacerbation within the last year
- Prior ICU admission for asthma exacerbation
- What physical exam signs would you look for to determine the severity of his asthma exacerbation?
The following physical sings indicate a severe asthma exacerbation:- Unable to speak in full sentences
- Respiratory distress
- Pulsus paradoxus
- “silent chest”
- Hypoxia
- Peak flow <150L/min is very worrisome
- What is your acute management of this patient?
Acute management of an asthma exacerbation includes the following:- Stabilize ABCs
- Short acting beta agonist: Ventolin 4-8 puffs q10min x3
- Short acting anticholinergic: Atrovent 4-8 puffs q10min x3
- Steroids: Prednisone 40-80mg PO OD x7-10d
- O2 supplementation to keep O2 sat > 90%
Resource
Lazarus SC. Clinical practice. Emergency treatment of asthma. N Engl J Med. 2010, 363:755-764.
