Question

Management of acute severe asthma

Hint:

In acute severe asthma, ensure rapid administration of bronchodilators and corticosteroids to prevent progression to respiratory failure.

Answer 1

Step 1: Understanding acute severe asthma.
Acute severe asthma is a medical emergency characterized by sudden worsening of asthma symptoms, including severe shortness of breath, wheezing, and difficulty speaking. This condition requires immediate medical intervention to prevent respiratory failure.

Step 2: Initial Management.
- Oxygen Therapy: Administer oxygen to maintain oxygen saturation levels above 90%. Oxygen is crucial in preventing hypoxemia and respiratory failure.
- Inhaled Bronchodilators: Short-acting beta-agonists (SABA) like albuterol or salbutamol are the first-line therapy. They help relax the bronchial muscles and relieve wheezing and breathlessness. Inhaled anticholinergics (e.g., ipratropium bromide) may also be used in combination for more effective bronchodilation.
- Systemic Steroids: Oral or intravenous steroids such as prednisone or methylprednisolone are given to reduce inflammation and improve lung function.

Step 3: Severe Asthma Management.
- Continuous Nebulization: For severe cases, nebulized bronchodilators may be given continuously to improve airflow.
- Intravenous Magnesium Sulfate: Magnesium sulfate may be administered in cases of refractory severe asthma to help relax the muscles and improve airflow.
- Mechanical Ventilation: If there is no response to pharmacological therapy and the child is in respiratory failure, intubation and mechanical ventilation may be required.
- Monitoring: Continuous monitoring of vital signs, peak expiratory flow rate (PEFR), and oxygen saturation is essential for assessing response to therapy.

Step 4: Conclusion.
Acute severe asthma requires prompt management with oxygen therapy, bronchodilators, and corticosteroids. In refractory cases, advanced treatments like magnesium sulfate or mechanical ventilation may be necessary. Early intervention is critical in preventing respiratory failure.