Assess the severity: 

Moderate:  

 Peak expiratory flow rate: 50 to 79% best (or predicted if best not available) 

 Sats: ≥92% 

 Speech: normal 🗣

 Respiratory rate: <25 

 Pulse: <110 💓

Severe: 

 Peak expiratory flow rate: 33 to 50% best (or predicted if best not available) 

 Sats: ≥92% 

 Speech: cannot finish sentence in one breath 🗣

 Respiratory rate: ≥25 

 Pulse: ≥110 💓

Life threatening (ADMIT IMMEDIATELY if presence of any one of the following): 

 Peak expiratory flow rate: <33% best (or predicted if best not available) 

 Sats: <92% or cyanosis 

 Feeble respiratory effort or silent chest 

 Hypotension or arrhythmia 

 Exhaustion or altered consciousness 💤

Management: 

Moderate:  

 No oxygen required ❌ 

 SALBUTAMOL (up to 10 puffs via spacer) 

 ORAL PREDNISOLONE (40 to 50mg for 5+ days until recovered) 💊

Severe: 

 OXYGEN required to maintain sats between 94 and 98% 

 SALBUTAMOL (5mg nebulised/ up to 10 puffs via a spacer) 

 ORAL PREDNISOLONE (40 to 50mg for 5+ days until recovered) 💊

Life threatening: 

 OXYGEN required to maintain sats between 94 and 98% 

 SALBUTAMOL and IPRATROPIUM (5mg and 0.5mg respectively, nebulised via oxygen) 

 ORAL PREDNISOLONE (40 to 50mg) or HYDROCORTISONE (100mg iv) 💊

❗ONLY GIVE ANTIBIOTICS IF THERE IS EVIDENCE OF INFECTION❗ 

Hospital Admission: 

 Wait for the ambulance to arrive 🚑

 Repeat nebulisers as required whilst waiting 🔄

The threshold for admission should be lower in the following circumstances: 

 The patient was recently admitted 🏨

 Attack occurs in the afternoon or evening 

 The patient cannot assess their own symptoms 

 The patient has had recent nocturnal symptoms 🌙

 You are concerned about their social situation 

Moderate: 

 Should be admitted if they have a history of near-fatal asthma attacks 💀

 Most patients can be discharged if condition is improving 

 You should review their drugs, and assess whether you need to increase them or not 💊

Severe: 

 Determine whether admission required by response to treatment administered 💊

 If symptoms persist, admit patient 

Life threatening: 

 ADMISSION URGENTLY REQUIRED 🏨

Post-admission: 

 Primary care follow-up within 48 hours following discharge: 

 Check symptoms  

 Measure peak flow 

 Check the patient’s inhaler technique and their understanding of inhalers 

 Increase treatment plan if necessary ⬆  

 Ensure patient is familiar with their Personal Asthma Action Plan 

 Discuss triggers to avoid to reduce risk of future admission 🏨

What are common causes of death? 

 Patients not recognising the severity of their condition 

 Poor assessment of severity by doctors 🏨

 Corticosteroids not given enough  

Summary:

1. Acute asthma in adults can be defined as: moderate, severe, or life-threatening
2. Management varies depending on how it is classified, increasing in intensity
3. Hospital admission threshold should be lowered if the patient was recently admitted, has the attack in the afternoon or evening, if you are concerned about their social situation, they have nocturnal symptoms, and if they cannot assess their own symptoms
4. After hospital admission, you must follow-up with the patient within 48 hours and make sure they are familiar with their Personal Asthma Action Plan