Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

going through acute asthma. And if you want to follow along with written notes on this topic,

you can follow along at zero definals.com slash acute asthma or in the respiratory section of

the Zero to Finals Pediatrics book. So let's get straight

into it. An acute exacerbation of asthma is characterized by a rapid deterioration in the symptoms of

asthma. And this could be triggered by any of the typical asthma triggers such as infection,

exercise or cold weather. The presentation involves a rapid

worsening and symptoms of shortness of breath, signs of respiratory distress, a fast respiratory

rate which we call tachyknea, expiratory wheeze on a auscultation heard throughout the chest.

The chest can sound tight on auscultation

with reduced air entry and something called a silent chest which is a very ominous sign.

And this is where the airways are so tight it's not possible for the child to move enough air

through the airways to create a wheeze. And this might be associated with reduced respiratory effort due to

fatigue. So a less experienced practitioner may think that because there's no respiratory distress and

no wheeze, the child is not as unwell. However, in reality a silent chest is life-threatening.

Let's talk about assessing the severity, and it's important to assess

the severity of asthma to guide how aggressively you treat the child. And these criteria are adapted

from the BTS or British Thoracic Society and the sign guidelines from 2016. The things that would

suggest a moderate exacerbation of asthma would be a peak flow

above 50% predicted, normal speech, and none of the features that I'm going to list of

severe or life-threatening asthma.

Features that would make you consider severe asthma would be a peak flow below 50% predicted, oxygen saturations

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