From the Guidelines
The priority vital sign to attend to in a patient with acute asthma exacerbation and significant airway obstruction is oxygen saturation (SpO2), as hypoxemia represents the most immediate threat to life in severe asthma. According to the guidelines for managing asthma exacerbations 1, the severity of asthma exacerbations is categorized based on symptoms, signs, and functional lung assessment, including arterial oxygen saturation (SaO2). Ensuring adequate oxygenation is critical as the narrowed airways in asthma impair oxygen exchange, potentially leading to respiratory failure.
The patient's vital signs, including a respiratory rate of 24, heart rate of 115, and temperature of 100.20 F, indicate a severe asthma exacerbation. The peak flow of 175L/min is significantly lower than normal, further supporting the severity of the exacerbation.
- Key considerations in managing this patient include:
- Administering supplemental oxygen to maintain oxygen saturation at 93-95% or higher, as recommended by the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations 1
- Initiating bronchodilator therapy, such as albuterol, to address the underlying bronchoconstriction
- Prescribing systemic corticosteroids, such as prednisone, to reduce inflammation
- Continuously monitoring the patient's oxygen levels, respiratory rate, heart rate, and work of breathing to assess the response to treatment and adjust the management plan as needed.
The British Thoracic Society guidelines 1 also emphasize the importance of immediate treatment for severe asthma, including oxygen therapy, bronchodilators, and corticosteroids. However, the most recent and highest-quality study 1 prioritizes oxygen saturation as the key vital sign to attend to in acute asthma exacerbation.
In this case, the patient's oxygen saturation should be prioritized, and supplemental oxygen should be administered immediately to maintain adequate oxygenation, while simultaneously initiating other treatments to address the underlying bronchoconstriction and inflammation.
From the Research
Vital Sign Priority in Acute Asthma Exacerbation
In a patient with acute asthma exacerbation and signs of significant airway obstruction, the priority vital sign to attend to is the respiratory rate.
- The patient's respiratory rate is 24, which is elevated, indicating respiratory distress 2.
- The patient's peak flow is 175L/min, which is decreased, indicating significant airway obstruction.
- The patient's lung assessment reveals diffuse bilateral wheezes on expiration and occasionally on inspiration, and decreased breath sounds bilaterally, further indicating significant airway obstruction.
Rationale for Priority
The rationale for prioritizing respiratory rate is based on the following:
- Respiratory rate is a key indicator of respiratory distress and is closely monitored in patients with acute asthma exacerbation 3, 4.
- An elevated respiratory rate, such as in this patient, indicates increased work of breathing and potential respiratory failure 5, 2.
- The patient's symptoms, including shortness of breath, wheezing, and cough, also support the priority of respiratory rate.
Additional Considerations
Additional considerations in assessing vital signs in this patient include:
- Oxygen saturation, which is not provided in the scenario, but is an important vital sign to monitor in patients with respiratory distress 4, 5.
- Heart rate, which is elevated at 115, may also indicate respiratory distress or other underlying conditions 2.
- Blood pressure, temperature, and other vital signs should also be monitored, but are not the primary concern in this scenario 3, 6.