According to a National Asthma Campaign audit of 2001, 1,500 people die every year in the United Kingdom as a result of an exacerbation of asthma, which is the equivalent of four people every day. Ninety per cent of these deaths could have been prevented.
Ashma is a chronic inflammatory disorder of the airways. In susceptible individuals, inflammatory symptoms are usually associated with widespread but variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible either spontaneously or with treatment (British Thorax Society 2003).
Asthma can be classified according to its severity. Each classification has clear criteria outlined by the British Thoracic Society guidelines for asthma management (2003). The following information is reproduced with the kind permission of the British Thoracic Society.
Near Fatal Asthma
• raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures
Any one of the following in patients with severe asthma:
• Peak Expiratory Flow (PEF) <33% of best or predicted
• feeble respiratory effort
Acute Severe Asthma
• respiratory rate >25 per minute
• heart rate >110 beats/minute
• inability to complete sentences in one breath
Moderate Asthma Exacerbation
• increased symptoms
• no features of acute severe asthma
• Type 1: wide PEF variability (>40% diurnal variation for >50% of the time over more than 150 days despite intensive therapy)
• Type 2: sudden severe attacks on a background of apparently well controlled asthma
The British Thoracic Society has devised flow charts for the assessment of patients with exacerbation of asthma presenting to the Emergency Department. These guidelines should be utilised for all patient presenting to the Medical Assessment Unit with an exacerbation of asthma (see Figure 5.1).
When following the BTS guidelines it remains advisable to use a structured ABCDE approach in your assessment.
• Assess and maintain airway.
• Utilise head tilt, chin lift if necessary.
• Use airway adjuncts if required.
• Consider urgent referral to anaesthetist for intubation if unable to protect airway or patient has life-threatening or acute severe asthma.
• If airway compromised or patient has symptoms and signs of life-threatening or acute severe asthma, ensure medical assistance is summoned immediately.
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.