Asthma is a common disease and presents to acute healthcare services extremely frequently.

The majority of presentations are mild exacerbations of a known diagnosis and are relatively simple to assess and treat, many being completely appropriate for out patient treatment.

On the other hand around 200 deaths per year are attributable in the UK to asthma, and therefore in the relatively young group of patients there is a real potential for critical illness with catastrophic consequence if not treated effectively. The majority of these deaths occur prior to the patient making it to hospital making the prehospital phase extremely important and hugely stressful in these cases.

It is also worth noting that of the deaths reported that many were associated with inadequate inhaled corticosteroids or steroid tablets and inadequate follow up, meaning that our encounter with these patients at all stages of their care even if not that severe at the point of assessment is a key opportunity to discuss and educate about treatment plans and reasons to return.

In part 1 of this podcast we will run through

• Pathophysiology
• How patients present
• Guidelines
• Treatment
  • Salbutamol
  • Ipratropium
  • Steroids
  • Magnesium

Part 2 will be out shortly, we hope you enjoy the episode and would love to hear your feedback!

Simon, Rob & James

References & Further Reading

BTS Asthma Guidelines 2016

Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Goodacre S. Lancet Respir Med. 2013 

Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Sauter TC. Emerg Med J. 2017

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Laan DV. Injury. 2016

TheResusRoom; Needle Thoracostomy podcast

TheResusRoom; BTS Asthma Guidelines 2016 podcast

LITFL; Non-invasive ventilation (NIV) and asthma

Intensiveblog; Asthma mechanical Ventilation Pitfalls

BestBets; In a severe Exacerbation of asthma can Ketamine be used to avoid the need for mechanical ventilation in adults?