this guideline based on recent articles by major education establishments concerned with building national guidelines. please dont be hurry to make comments about use of IV aminophylline. aminiphylline used under some extra care and when other treatment options are failing. benefits of those treatments yet remain controversial. IV aminophylline has its own risks including the possibility of toxicity.

1. Management of acute
severe asthma
Lecture-8
By Dr-c

2. What is Asthma?
• Asthma attacks all age groups but often starts in childhood. It is a
disease characterized by recurrent attacks of breathlessness and
wheezing, which vary in severity and frequency from person to person.
In an individual, they may occur from hour to hour and day to day.
• This condition is due to inflammation of the air passages in the lungs
and affects the sensitivity of the nerve endings in the airways so they
become easily irritated. In an attack, the lining of the passages swell
causing the airways to narrow and reducing the flow of air in and out
of the lungs.
• -(WHO definition)
• There are many definitions with various point of views. The given one
here is acceptable and convenient. Or look in to BTS guidelines on
Asthma

3. Types of exacerbations
• Asthma exacerbations can be classified as mild, moderate, severe, or life
threatening.
• Classification of severity is based on several observations which are clinical. And
it also depends on oxygen saturation parameters.

5. Differential diagnosis of Acute severe asthma.
• bronchiolitis.
• Foreign body inhalation and
other causes of stridor (eg,
epiglottitis, croup, tracheitis,
vascular ring, tracheomalacia,
etc).
• Allergic reaction, anaphylaxis.
• Pneumothorax
• Acute exacerbations of
chronic obstructive
pulmonary disease (COPD).
• Bronchiectasis.
• Cardiac failure ('cardiac
asthma').
• etc

6. Diagnosis
• Obviously patient will have a known history of asthma mist of the time.
• Auscultate.
• Assess breathing efforts.
• By one parameter only we cant say the patient is having a severe attack.
• Use clinical features together with PEF
• If PEF<40 definitely the patient needs to be admitted to ward. And he might be
having a severe asthma attack.
•

7. Clinical features of Acute severe asthma
• Use of accessory muscles of respiration,
• Intercostal recessions.
• Tachypnea,
• Cyanosis
• Tachycardia, [might be due to beta 2 agonists also.]
• Wheezing on both inspiration and expiration.
• Patient might not be able to complete a word[difficult to talk]
• Conscious level may be deteriorating.
• patient may be distressed.
• Low oxygen saturation

8. Initial measures.
• Usually these patients have a known history of asthma.
• If the patients are compliant with the treatments
admission rates are drastically low. And the severity also
not life-threatening.
• Previous history of life-threatening asthma, acute severe
asthma an indicator of possible next severe attack.

9. Home/initial treatment measures.

10. Management protocol
• Given acute severe asthma management algorithm based on guidelines by
American collage of family physicians.
• Given diagram below continues for three slides.
• Can be seen in aafp.org
• Link https://www.aafp.org/afp/2011/0701/p40.html

13. Continuation of previous slide

14. Guidelines by British thoracic society
• Algorithm extends for few slides.
• Guideline can be downloaded from BTS web page

21. Other points to be remembered
• The addition of intravenous aminophylline to conventional
therapy in children and adults has no additional benefit in
reducing hospital admissions. It does significantly increase the risk
of adverse effects, including vomiting, palpitations, and
arrhythmias
• There are insufficient data to recommend for or against the use of
antibiotics in the treatment of acute exacerbations(if you are going
to give some AB make sure there is a reason to give so. Ex-in a
situation of suspected pneumonia)

22. Comments regarding IV aminophylline
• IV aminophylline used when all other options are failing.
• IV Aminophylline has own risks including its toxicity.
• Some guidelines emphasize the use of this drug while others are giving it as a
distant option. Anyway if there is an stem in question like this “IV aminophylline
can be used in Acute severe asthma”-> don’t mark this as wrong.
• IV aminophylline not widely used. But it can still be used. So don’t rush to make
a strong comment.
• Under a pediatricians or physicians supervision still aminophylline is used.

23. Other points to remember
• high-dose mucolytics, antihistamines, chest physiotherapy, and
sedation are all unproven treatments.(americal association of family
physicians)

24. • Given information is the basics of ward management and most of the slides covers
the points in MBBS(MCQ,SBA) and ERPM exam questions.
• Some theories are new because the slides are based on new guidelines.
• Read and compare with your knowledge.
• Remember asthma might kill a person. Start by the basics. And remember the
treatment algorithms
• Previous guidelines will also be uploaded in another lecture but that’s for your
knowledge only or exam survival.
• Thank you
Dr-C