Asthma is common and potentially fatal.
- Severity – Severe or Life threatening – think RESUS
- Treatment within 30 min – bronchodilators and steroids should bee given within 30min
- 2hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
- PEFR – must be >75% expected prior to discharge
- Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer
Life Threatening Asthma
- Involve Seniors and ICU early
- Consider IV therapy early
- IV Magnesium – 2g over 20min
- IV Salbutamol – BNF here
- Loading – 250 micrograms, repeated if necessary, injection to be diluted to a concentration of 50 micrograms/mL
- Infusion – Initially 5 micrograms/minute, adjusted according to response and heart rate, usual dose 3-20 micrograms/minute
- IV Aminophylline (IV Salbutamol OR Aminophylline not both) – BNF Here
- Loading – 250–500 mg (max. per dose 5 mg/kg), to be followed by intravenous infusion
- Infusion (Adult) – 500–700 micrograms/kg/hour, adjusted according to plasma-theophylline concentration.
- Infusion (Eldery) – 300 micrograms/kg/hour, adjusted according to plasma-theophylline concentration.
Potential Discharges – BTS
- In all patients who received nebulised β2 agonists prior to presentation, consider an extended observation period prior to discharge
- If PEF<50% on presentation, give prednisolone 40–50 mg/day for 5 days
- In all patients ensure treatment supply of inhaled steroid and β2 agonist and check inhaler technique
- Arrange GP follow up within 2 working days postdischarge
- Refer to asthma liaison nurse/chest clinic