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
- MDI = 4-8 puffs 100 mcg q20 mins for the first hour
- 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