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Management of Asthma Exacerbation

Asthma: episode airflow obstructive symptoms that are at least partially reversible

  • Triad of exacerbation
    • Progressive bronchoconstriction
    • Airway inflammation
    • Mucus plugging

Asthma exacerbation

Mild

  • Definition: SOB on exacerbation or symptoms at night. Can speak full sentences with some difficulty.
  • Management:
    • CXR if first presentation
    • Salbutamol
      • MDI = 4-8 puffs 100 mcg every 20 mins for the first hour
      • Decrease to 2 to 6 puffs q3-4 hours

Moderate

  • Definition: SOB at rest with cough and chest tightness. Can speak short phrases.
  • Management:
    • Supplemental oxygen if < 92 %
    • Salbutamol (SABA)
      • MDI = 4-8 puffs 100 mcg q20 mins for the first hour
        • Decrease to 6 to 10 puffs q1-2 hours
      • Nebulizer = 2.5-5 mg q15-20 minutes
    • Ipratropium bromide (SAMA)
      • MDI = 4-8 puffs 20 mcg q15-20 minutes
      • Nebulizer = 0.25-0.5 mg q15-20 minutes
    • Prednisone 40 to 60 mg PO (usually duration of 5 to 7 days) OR 1 mg/kg PO daily

Severe

  • Definition: Signs of respiratory distress and labored breathing. Can speak only words.
  • Management:
    • Supplemental oxygen if < 92 %
    • Salbutamol (SABA)
      • MDI = up to 20 puffs 100 mcg within 10-20 minutes
      • Nebulizer = 2.5-5 mg q15-20 minutes
    • Ipratropium bromide (SAMA)
      • MDI = up to 20 puffs 20 mcg within 10-20 minutes
      • Nebulizer = 0.25-0.5 mg q15-20 minutes
    • Methylprednisolone 1 mg/kg IV x 5-7 days
    • Magnesium sulfate 2 g IV over 20 minutes
    • Consider intubation
    • Place cardiac monitors