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Life threatening asthma in general practice

Authoring team

On assessment:

  • PEF < 33% of predicted or best
  • SpO2 <92%
  • silent chest, cyanosis or poor respiratory effort
  • arrhythmia or hypotension
  • exhaustion, altered consciousness

Action:

  • arrange immediate ADMISSION to hospital
  • stay with the patient until the ambulance arrives

Treatment:

  • oxygen - to maintain SpO2 94–98%
  • β2 bronchodilator and ipratropium:
    • nebuliser (preferably oxygen driven) (salbutamol 5 mg and ipratropium 0.5mg)
    • or via spacer (give 4 puffs initially and give a further 2 puffs every 2 minutes according to response up to maximum of 10 puffs)
  • prednisolone 40–50 mg or IV hydrocortisone 100 mg immediately

Follow up after treatment or discharge from hospital:

  • GP review within 2 working days
  • monitor symptoms and PEF
  • check inhaler technique
  • provide a written asthma plan
  • modify treatment according to guidelines for chronic persistent asthma
  • address potentially preventable contributors to admission

Reference:

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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