Life threatening asthma in general practice

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:

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