Asthma – Adult

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 SalbutamolBNF 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

PDF:asthma adult(inc. advice sheet)

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