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Home » , , , » Summary of treatment of acute attacks of asthma in adults
Summary of treatment of acute attacks of asthma in adults
Sunday, October 2, 2011 Posted by Piscean





Summary of treatment of acute attacks of asthma in adults 
Mild attack
Moderate attack
Severe attack
oxygen therapy
usually not necessary
if available—to maintain SaO2 above 94%
yes—to maintain SaO2 above 94%
short-acting beta2 agonists (SABA)
1. salbutamol 100 micrograms MDI, 4–10 inhalations (preferably via a large-volume spacer) or 2.5–5 mg by nebuliser, 3- to 4-hourly
1. salbutamol 100 micrograms MDI, 4–10 inhalations (preferably via a large-volume spacer) or 5 mg by nebuliser, 1- to 4-hourly
1. salbutamol 5 mg by nebuliser driven by oxygen (at least 8 L/min). If there is no response to the initial dose, repeat immediately, then every 15–30 minutes or give continuously[NB]
OR
OR
OR
1. terbutaline 500 micrograms DPI, 2-4 inhalations (max. 12 inhalations/day) or 5-10 mg by nebuliser, 3- to 4-hourly
1. terbutaline 500 micrograms DPI, 2-4 inhalations (max 12 inhalations/day) or 5-10 mg by nebuliser, 1- to 4-hourly
1. terbutaline 5 mg by nebuliser driven by oxygen (at least 8 L/min). If there is no response to the initial dose, repeat immediately, then every 15-30 minutes or give continuously
ipratropium bromide
(optional, in addition to SABA)
ipratropium bromide 20 micrograms MDI, 4–8 inhalations (preferably via a large-volume spacer), 4-hourly
OR
ipratropium bromide 500 micrograms by nebuliser, 4-hourly
ipratropium bromide 500 micrograms by nebuliser driven by oxygen (at least 8 L/min) 2- to 4-hourly
adrenaline
for anaphylaxis or imminent cardiorespiratory arrest:
adrenaline 0.5 mg (0.5 mL of 1:1000 ampoule) diluted to 10 mL total volume slowly IV, or 0.5 mg (0.5 mL of 1:1000 ampoule) subcutaneously, IM or via endotracheal tube
corticosteroids
consider starting ICS or increasing the usual dose for a short time
prednisolone 25–50 mg orally, daily until attack improves then reduce as appropriate for the patient
consider also starting ICS or increasing the usual dose for a short time
1. prednisolone 50 mg orally, daily until asthma is controlled then reduce as appropriate for the patient
OR
2. hydrocortisone 100 mg IV, 6-hourly (or equivalent dose of alternate corticosteroid) then review and convert to oral therapy when appropriate
magnesium sulfate (IV)
consider if poor response to initial treatment: 1.2–2 g IV over 20 minutes
hospital admission
usually not necessary
often necessary
yes; consider ICU admission
further management
? chest X-ray
· chest X-ray
· check for hypokalaemia
· may require assisted ventilation


ICS = inhaled corticosteroids; MDI = metered dose inhaler; DPI = dry powder inhaler; ICU = intensive care unit; SaO2 = oxygen saturation
[NB] continuous administration requires a diluted solution, see product information

Piscean

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