Clinical differentiation between acute severe asthma exacerbations

how to clinically differentiate a case of acute severe asthma(Where SABA+IV Hydrocorticose) is to be given from Type 2 brittle asthma where SC Epinephrine is to be given.?

Clinical differentiation between acute severe asthma exacerbations and Type 2 brittle asthma requires a thorough assessment by healthcare professionals. Here are some general characteristics that may help distinguish between the two:

Acute Severe Asthma:

  1. Clinical Presentation:
  • Rapid onset of symptoms.
  • Severe breathlessness, wheezing, and chest tightness.
  • Use of accessory muscles for breathing.
  • Inability to complete sentences due to breathlessness.
  1. Response to Standard Therapy:
  • Typically responds well to inhaled short-acting beta-agonists (SABA) and systemic corticosteroids.
  1. Triggers:
  • Often triggered by identifiable factors such as viral infections, allergens, or pollutants.
  1. Medical History:
  • May have a history of intermittent asthma with exacerbations.
  • Response to rescue inhalers (SABA) is generally effective.
  1. Lung Function Tests:
  • Demonstrates reversible airflow limitation on spirometry after bronchodilator use.
  1. Blood Gases:
  • Arterial blood gases may show respiratory alkalosis due to hyperventilation.

Type 2 Brittle Asthma:

  1. Clinical Presentation:
  • Recurrent severe asthma exacerbations with sudden and unpredictable onset.
  • Wide variations in peak flow readings or lung function.
  • Frequent hospitalizations.
  1. Response to Standard Therapy:
  • Poor response to standard therapy, and may require higher doses of medications.
  1. Triggers:
  • Triggers may not be easily identifiable, and episodes may occur without an apparent cause.
  1. Medical History:
  • History of recurrent severe exacerbations with poor response to standard therapy.
  1. Lung Function Tests:
  • May show persistent airflow limitation even after treatment.
  1. Blood Gases:
  • Blood gases may reveal respiratory or metabolic acidosis during severe exacerbations.

Epinephrine Use:

  • Epinephrine is not typically used in the routine management of acute severe asthma but may be considered in Type 2 brittle asthma during acute exacerbations.

It’s important to emphasize that these are general guidelines, and individual cases may vary. Healthcare providers should make the final diagnosis and treatment decisions based on a thorough assessment of the patient’s clinical condition, medical history, and response to interventions. Always follow local and clinical guidelines, and seek immediate medical attention for any acute respiratory distress.