Asthma – Adult

  • Severity – Severe or Life threatening – think RESUS
  • Treatment within 30 min – bronchodilators and steroids should bee given within 30min
  • 1hrs 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 (at least 1hr after treatment finished)
  • Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer

Severity Assessment





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
  • Prednisolone 40–50 mg/day for 5 days
  • Ensure treatment supply of inhaled steroid and β2 agonist and check inhaler technique
  • Ensure GP letter completed
  • Refer to asthma liaison nurse/chest clinic

BTS: Full Guide here

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