Summary of treatment of acute attacks of asthma in adults
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 | ||
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