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Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.

Using the latest guidelines from the Australia and New Zealand Thoracic Society (ANZTS), the British Thoracic Society (BTS) or a source that draws on these resources, compare and contrast the differences between life‐threatening asthma and anaphylaxis, and explain why this is more likely to be asthma than any other differential diagnosis.

Similarities: asthma and anaphylaxis both present with respiratory distress and a wheeze. Both are due to an inflammatory response. And both may appear flushed – from exertion in asthma, and in anaphylaxis the skin’s reaction to the allergen.

Differences: in anaphylaxis the whole airway can be affected, producing particular symptoms not associated with asthma, such as voice changes, stridor, inspiratory wheeze and tongue and lip swelling. Also asthma is predominantly a respiratory problem, whereas anaphylaxis can present with gastrointestinal problems and hypotension, which can lead to distributive shock.

Although this did occur after eating, the patient seems to be presenting with symptoms limited purely to the respiratory system. There are no dermatological, gastrointestinal or cardiovascular changes that would indicate anaphylaxis.

1  Is this patient suffering from moderate, severe or life‐threatening asthma, and why? Life‐threatening asthma. See Table 1.4.Table 1.4 Comparison of asthma severitySource: British Thoracic Society (2019).Near‐fatal asthmaRaised PaCO2 and/or requiring mechanical ventilation with raised inflation pressuresLife‐threatening asthmaIn a patient with severe asthma any one of: PEF <33% best or predicted SpO2 <92% PaO2 <8 Kpa ‘Normal’ PaCO2 (4.6–6.0 Kpa) Altered conscious level Exhaustion Arrhythmia Hypotension Cyanosis Silent chest Poor respiratory effortAcute severe asthmaAny one of: PEF 33–50% best or predicted Respiratory rate ≥25/min Heart rate ≥110/min Inability to complete sentences in one breathModerate acute asthmaIncreasing symptoms PEF >50–75% best or predicted No features of acute severe asthma

1  List your treatment, route and dosages. Adrenaline – 500 μg IM.Salbutamol – 5 mg nebulised.Ipatropium bromide – 500 μg nebulised.Oxygen – 6/8 L.Hydrocortisone – 100 mg IV (IM possible if unable to gain IV access).