Immediate treatment

High flow oxygen via tight fitting face mask or nasal cannulae at sufficient rate to maintain oxygen saturations greater than 92%.

Give a trial of ß2 agonist

• salbutamol up to 10 puffs via spacer (given one puff at a time inhaled separately using tidal breathing) and face mask or nebulised salbutamol 2.5 mg
• repeat β2 agonist every 1–4 hours if responding
• if poor response:
  • add 0.25 mg nebulised ipratropium bromide to each β2 agonist nebuliser every 20–30 minutes for 1–2 hours

Consider systemic steroids:

• oral prednisolone 10 mg daily for upto 3 days

Continuous close monitoring of the following is necessary:

• heart rate
• pulse rate
• pulse oximetry (1)

Reference:

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