Acute severe asthma in general practice

On assessment:

• PEF 33–50% best or predicted
• SpO2 ≥92%
• cannot speak in completed sentences
• has a pulse rate of ≥110 beats/min
• respiratory rate ≥25 breaths/min

Management:

• serious consideration for immediate admission if more than one feature of the above present.

Treatment:

• give oxygen to maintain SpO2 94–98% if available
• β2 bronchodilator:
  • nebuliser (preferably oxygen driven) (salbutamol 5 mg)
  • 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)
• oral prednisolone 40–50 mg or IV hydrocortisone 100 mg

Monitor response 15-30 minutes after nebuliser therapy.

If any signs of acute severe asthma persist then arrange hospital admission.

• remain with patient until ambulance arrives
• send written asssessment and referral details to hospital
• β2 bronchodilator via oxygen-driven nebuliser in ambulance (1)

Follow-up:

• monitoring of symptoms and PEF
• give self management plan
• review at GP surgery in <= 24 hours

At review, modify treatment according to guidelines for chronic persistent asthma.

Reference:

• (1) British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2016. British Guideline on the Management of Asthma. A national clinical guideline