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Asthma - Management
Hospital admission required
Children and adults who need admission to hospital: How do I manage?
- Organize urgent hospital admission.
- Give high-flow oxygen (40–60%) with a tight-fitting mask. If pulse oximetry is available, adjust the flow rate to maintain an oxygen saturation of 94–98%.
- Give a short-acting inhaled beta2-agonist:
- For life-threatening asthma, give via a nebulizer, if available. Repeat every 20–30 minutes according to clinical response.
- Ideally, nebulizers should be oxygen driven (flow rate of 6 L/min usually needed) to avoid worsening hypoxia.
- For severe attacks, give via a nebulizer (preferred for children if available) or use a pressurized metered-dose inhaler with a large-volume spacer.
- For an adult, give 4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs.
- For a child, give 2 puffs every 2 minutes according to response, up to 10 puffs.
- Each puff should be given one at a time and inhaled with five tidal breaths. Repeat every 10–20 minutes according to clinical response.
- For moderate attacks, use a pressurized metered-dose inhaler with a large-volume spacer.
- Give the first dose of a course of prednisolone.
- Monitor peak expiratory flow rate (if the person can comply) and oxygen saturation (if available) to assess response to treatment.
- If the person does not respond to a beta2-agonist, consider continuous nebulized beta2-agonists or addition of ipratropium bromide (via a nebulizer). However, aim to get the person to hospital urgently.
In depth
What follow up is recommended after an exacerbation of asthma?
- One week after an asthma exacerbation in all people:
- Assess the exacerbation:
- Ask about the duration and severity of the exacerbation compared with any previous episodes. Record the number of exacerbations and hospital admissions.
- Identify possible trigger factors, such as exercise, work, or allergens.
- Optimize treatment:
- Ask about compliance with treatment before the exacerbation and review the person's inhaler technique (correcting problems).
- Provide advice on lifestyle, vaccinations, diet, exercise, and smoking. If the individual or parent of the child smokes, advise them to stop.
- Consider stepping-up treatment by increasing inhaled corticosteroids or adding in new preventive therapy.
- Review self-management education and written action plan:
- Review the person's understanding of how to recognize an exacerbation and what to do at the early signs of an exacerbation (increase beta2-agonist and start oral corticosteroids).
- Reinforce understanding by updating the written action plan.
In depth
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