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Assess for Life-Threatening Features
Assess for Life-Threatening Features
Cyanosis (fingertips or under tongue)
Respiratory exhaustion
Low GCS
Shift to crash room
Involve senior early
Consider definitive airway management / non-invasive ventilation
Begin asthma-specific therapy
Send blood gas
Assess for Severe Features
Assess for Severe Features
RR > 30 breaths/min
HR > 120 bpm
Use of accessory muscles
Diaphoresis
Unable to speak full sentences/phrases
Unable to lie supine due to breathlessness
Pulsus paradoxus
Actions:
Actions:
Shift to crash room
Involve senior
Consider Alternative Diagnoses
Consider Alternative Diagnoses
Look for:
Fever, purulent sputum → pneumonia, bronchiectasis
Urticaria → anaphylaxis
Pleuritic chest pain → pneumothorax
Core Management
Core Management
Titrate oxygen to keep SpO₂ ≥ 92%
Start nebulized salbutamol + ipratropium (q20 min or continuous)
IV methylprednisolone or PO prednisolone 1 mg/kg
Reassess every 30 min:
Accessory muscle use
Wheeze
SpO₂
RR, HR, BP
5. Call pulmonology
Escalation: Severe, Worsening, or Life-Threatening
Escalation: Severe, Worsening, or Life-Threatening
Continue above measures
Add: MgSO₄ 2 g IV in 5% DW over 20 min (watch for respiratory depression)
Consider definitive airway management/noninvasive ventilation
Discharge Criteria
Discharge Criteria
Vital signs stable
Off oxygen
Normal respiratory rate
No accessory muscle usage
Discharge Instructions
Discharge Instructions
Follow-up with pulmonology
Return immediately if:
Trouble speaking in full sentences
Shortness of breath worsens
Salbutamol needed more often than every 4 hours
Home Medications
Home Medications
Salbutamol + ipratropium inhaler as needed
PO prednisolone 1 mg/kg in 2 divided doses daily × 5 days (+ esomeprazole if needed)
If not already on controller: Seretide inhaler 250/25, 2 puffs BID (even when symptom-free)
Ensure correct inhaler technique
References
References
EB Medicine: Asthma
Author: Faysal Subhani
Editor: Ayesha Saeed
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