Asthma Management - Adults
Asthma Management - Adults
Asthma Management - Adults
Annex 4
Management of acute severe asthma in adults in hospital
IMMEDIATE TREATMENT
Features of acute severe asthma
Oxygen to maintain SpO2 94-98%
Peak expiratory flow (PEF) 33-50% of Salbutamol 5 mg or terbutaline 10 mg via an oxygen-driven nebuliser
best (use % predicted if recent best Ipratropium bromide 0.5 mg via an oxygen-driven nebuliser
unknown) Prednisolone tablets 40-50 mg or IV hydrocortisone 100 mg
Can’t complete sentences in one breath No sedatives of any kind
Respirations ≥25 breaths/min Chest X ray if pneumothorax or consolidation are suspected or patient
Pulse ≥110 beats/min requires mechanical ventilation
Blood gas markers of a life threatening IF PATIENT NOT IMPROVING AFTER 15-30 MINUTES:
attack: Continue oxygen and steroids
‘Normal’ (4.6-6 kPa, 35-45 mmHg) Use continuous nebulisation of salbutamol at 5-10 mg/hour if an appropriate
PaCO2 nebuliser is available. Otherwise give nebulised salbutamol 5 mg every 15-30
Severe hypoxia: PaO2 <8 kPa minutes
(60mmHg) irrespective of treatment with Continue ipratropium 0.5 mg 4-6 hourly until patient is improving
oxygen
A low pH (or high H+) IF PATIENT IS STILL NOT IMPROVING:
Discuss patient with senior clinician and ICU team
Caution: Patients with severe or life Consider IV magnesium sulphate 1.2-2 g over 20 minutes (unless already given)
threatening attacks may not be distressed Senior clinician may consider use of IV β2 agonist or IV aminophylline or
and may not have all these abnormalities. progression to mechanical ventilation
The presence of any should alert the doctor.
640
620
520
500
480 Height
460
Men
190 cm (75 in) DISCHARGE
440
183 cm (72 in)
175 cm (69 in)
420 167 cm (66 in)
160 cm (63 in)
When discharged from hospital, patients should have:
400
Been on discharge medication for 12-24 hours and have had inhaler technique
380
360
checked and recorded
Height
340 Women PEF >75% of best or predicted and PEF diurnal variability<25% unless discharge is
183 cm (72 in)
320 175 cm (69 in)
167 cm (66 in)
agreed with respiratory physician
300
15 20 25 30 35 40 45 50 55 60 65 70 75 80
160 cm (63 in)
85 152 cm (60 in)
Treatment with oral and inhaled steroids in addition to bronchodilators
Age (years) Own PEF meter and written asthma action plan
Adapted by Clement Clarke for use with EN13826 / EU scale peak flow meters
from Nunn AJ Gregg I, Br Med J 1989:298;1068-70
GP follow up arranged within 2 working days
Follow up appointment in respiratory clinic within 4 weeks
Patients with severe asthma (indicated by need for admission) and adverse behavioural
or psychosocial features are at risk of further severe or fatal attacks
Determine reason(s) for exacerbation and admission
Send details of admission, discharge and potential best PEF to GP
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