Handling the Whole Patient: A Case of Asthma Exacerbation

Initial Assessment 3

Given her inability to complete sentences, her respiratory rate of 27/min and heart rate of 120/min
How severe is this acute exacerbation?

Mild
Moderate
Severe
Life-threatening
Near-fatal

Please answer each row

Well done, correct.

Feedback:

Based on the heart rate, tachypnoea and inability to speak in full sentences this is an acute severe asthma exacerbation
There are no features of life-threatening asthma
There are no features of near-fatal asthma

Moderate Acute Asthma	Increasing symptoms PEF >50-75% best or predicted No features of acute severe asthma
Acute Severe Asthma	Any one of: PEF 33-50% best or predicted Respiratory rate ≥ 25/min Heart rate ≥ 110/min Inability to complete sentences in one breath
Life Threatening Asthma	Any one of the following in a patient with severe asthma:
	Clinical Signs	Measurements
	Altered concious level	PEF <33% best or predicted
	Exhaustion	SpO₂ <92%
	Arrhythmia	PaO₂ <8 kPa
	Hypotension	'normal' PaCO₂ (4.6-6.0 kPa)
	Cyanosis
	Silent chest
	Poor respiratory effort
Near-fatal Asthma	Raised PaCO₂, and/or requiring mechanical ventilation with raised inflation pressures ^555-557

Table 15 from PDF - BTS Sign Guideline for the Management of Asthma 2019