Patient X presents with the following symptoms:
- acute shortness of breath
- unable to speak fluently
1. What is happening?
Bronchoconstriction – can be due to an allergic reaction to an allergen stimulus.
There are multiple reaction mechanisms which can trigger an asthma attack but they are all related to a “final common pathway” leading to:
- excess bronchial smooth muscle contraction
- excess mucus secretion
- vascular permeability leading to inflammation of the airways
These reactions to the responsible allergen make it harder for patient X to both inspire and expire air for respiration leading to an asthma attack.
The buildup of mucus is a good medium for bacteria to grow in asthma patients, increasing susceptibility to infection which can also lead to an asthma attack.
2. What do we do?
- check vitals
- follow the guidelines – British Thoracic Society Guidelines and BNF
- provide oxygen if hypoxaemic
- provide inhaled beta 2 agonist bronchodilators – high dose
- add nebuliser if no improvement
- single dose IV magnesium sulphate if no improvement and PEF <50% predicted
If life threatening:
- ipatropium bromide – 0.5 mg, 4-6 hourly
- intensive care referral
3. How do we prevent it from happening again?
Treatment usually involves inhalers which include:
- ICS- preventer inhaler with low dose inhaled corticosteroids, ICS
- LABA – Long acting beta agonists
- LTRA – Leukotriene receptor antagonists
- SR theophylline
- Beta agonist tablet
- LAMA – Long-acting muscarinic antagonist
- Steroid tablet
- Check BNF here
Usually we try to start off with low dose ICS inhalers the patient can use a few days a week. But if the condition progresses, tablets can be provided as it is often easier form of medication to take via the unaffected oesophagus. The systemic therapy can also act on allergic rhinitis and conjunctivitis asthma patients can also present with besides the respiratory tract issues.