Management Of Acute Asthma
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Management Of Acute Asthma

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Management Of Acute Asthma Management Of Acute Asthma Presentation Transcript

  • Management of acute asthma The British Thoracic Society Scottish Intercollegiate Guidelines Network Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
  • Patients at risk of developing near fatal or fatal asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 and Recognised by combination of: Severe asthma Adverse behavioural or psychosocial features
  • Patients at risk of developing near fatal or fatal asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 and Recognised by combination of: Adverse behavioural or psychosocial features
    • recognised by one or more of:
    • previous near fatal asthma (previous ventilation or respiratory acidosis)
    • previous asthma admission
    • requiring  3 classes of asthma medication
    • heavy use of ß 2 agonist
    • repeated attendances at A&E for asthma care
    • brittle asthma
    Severe asthma
  • Patients at risk of developing near fatal or fatal asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 and Recognised by combination of: Severe asthma
    • recognised by one or more of:
    • non-compliance with treatment or monitoring
    • failure to attend appointments
    • self-discharge from hospital
    • psychosis, depression, other psychiatric illness or deliberate self-harm
    • current or recent major tranquilliser use
    • denial
    • alcohol or drug abuse
    • obesity
    • learning difficulties
    • employment problems
    • income problems
    • social isolation
    • childhood abuse
    • severe domestic, marital or legal stress
    Adverse behavioural or psychosocial features
  • Lessons learnt from studies of asthma deaths Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Many deaths from asthma are preventable – 88-92% of attacks requiring
    • hospitalisation develop over  6 hours
    • Factors include:
    • inadequate objective monitoring
    • failure to refer earlier for specialist advice
    • inadequate treatment with steroids
    Health care professionals must be aware that patients with severe asthma and one or more adverse psychosocial factors are at risk of death B Respiratory specialist should follow up patients admitted with severe asthma for at least a year after admission  Keep patients who have had near fatal asthma or brittle asthma under specialist supervision indefinitely 
  • Levels of severity of acute asthma exacerbations Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Raised PaCO 2 and/or requiring mechanical ventilation with raised inflation pressures Near fatal asthma
  • Levels of severity of acute asthma exacerbations Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • silent chest
    • cyanosis
    • feeble respiratory effort
    • bradycardia
    • dysrhythmia
    • hypotension
    • exhaustion
    • confusion
    • coma
    Any one of the following in a patient with severe asthma: Life threatening asthma
    • PEF <33% best or predicted
    • SpO 2 <92%
    • PaO 2 <8 kPa
    • normal PaCO 2 (4.6-6.0 kPa)
    Raised PaCO 2 and/or requiring mechanical ventilation with raised inflation pressures Near fatal asthma
  • Levels of severity of acute asthma exacerbations Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • silent chest
    • cyanosis
    • feeble respiratory effort
    • bradycardia
    • inability to complete sentences in one breath
    • dysrhythmia
    • hypotension
    • exhaustion
    • confusion
    • coma
    Any one of: Acute severe asthma
    • PEF 33-50% best or predicted
    • respiratory rate  25/min
    • heart rate  110/min
    Any one of the following in a patient with severe asthma: Life threatening asthma
    • PEF <33% best or predicted
    • SpO 2 <92%
    • PaO 2 <8 kPa
    • normal PaCO 2 (4.6-6.0 kPa)
    Raised PaCO 2 and/or requiring mechanical ventilation with raised inflation pressures Near fatal asthma
  • Levels of severity of acute asthma exacerbations Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • No features of acute severe asthma
    • silent chest
    • cyanosis
    • feeble respiratory effort
    • bradycardia
    • inability to complete sentences in one breath
    • dysrhythmia
    • hypotension
    • exhaustion
    • confusion
    • coma
    Any one of: Acute severe asthma
    • PEF 33-50% best or predicted
    • respiratory rate  25/min
    • heart rate  110/min
    Any one of the following in a patient with severe asthma: Life threatening asthma
    • Increasing symptoms
    • PEF >50-75% best or predicted
    Moderate asthma exacerbation
    • PEF <33% best or predicted
    • SpO 2 <92%
    • PaO 2 <8 kPa
    • normal PaCO 2 (4.6-60 kPa)
    Raised PaCO 2 and/or requiring mechanical ventilation with raised inflation pressures Near fatal asthma
  • Levels of severity of acute asthma exacerbations Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • No features of acute severe asthma
    • silent chest
    • cyanosis
    • feeble respiratory effort
    • bradycardia
    • inability to complete sentences in one breath
    • dysrhythmia
    • hypotension
    • exhaustion
    • confusion
    • coma
    Any one of: Acute severe asthma
    • PEF 33-50% best or predicted
    • respiratory rate  25/min
    • heart rate  110/min
    Any one of the following in a patient with severe asthma: Life threatening asthma
    • Type 1: wide PEF variability (>40% diurnal variation for >50% of the time over a period >150 days) despite intense therapy
    • Type 2: sudden severe attacks on a background of apparently well-controlled asthma
    Brittle asthma
    • Increasing symptoms
    • PEF >50-75% best or predicted
    Moderate asthma exacerbation
    • PEF <33% best or predicted
    • SpO 2 <92%
    • PaO 2 <8 kPa
    • normal PaCO 2 (4.6-6.0 kPa)
    Raised PaCO 2 and/or requiring mechanical ventilation with raised inflation pressures Near fatal asthma
  • Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features
  • Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features
  • Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Necessary to determine adequacy of oxygen therapy and need for arterial blood gas measurement. Aim of oxygen therapy is to maintain SpO 2  92% Pulse oximetry Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features
  • Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Necessary for patients with SpO 2 <92% or other features of life threatening asthma Blood gases (ABG) Necessary to determine adequacy of oxygen therapy and need for arterial blood gas measurement. Aim of oxygen therapy is to maintain SpO 2  92% Pulse oximetry Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features
  • Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • failure to respond to treatment satisfactorily
    • requirement for ventilation
    Not routinely recommended in patients in the absence of: Chest X-ray
    • suspected pneumomediastinum or pneumothorax
    • suspected consolidation
    • life threatening asthma
    Necessary for patients with SpO 2 <92% or other features of life threatening asthma Blood gases (ABG) Necessary to determine adequacy of oxygen therapy and need for arterial blood gas measurement. Aim of oxygen therapy is to maintain SpO 2  92% Pulse oximetry Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features
  • Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • failure to respond to treatment satisfactorily
    • requirement for ventilation
    Not routinely recommended in patients in the absence of: Chest X-ray
    • suspected pneumomediastinum or pneumothorax
    • suspected consolidation
    • life threatening asthma
    Necessary for patients with SpO 2 <92% or other features of life threatening asthma Blood gases (ABG) Necessary to determine adequacy of oxygen therapy and need for arterial blood gas measurement. Aim of oxygen therapy is to maintain SpO 2  92% Pulse oximetry Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Abandoned as an indicator of the severity of an attack Systolic paradox Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features
  • Management of acute severe asthma in adults in A&E: assessment of PEF Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
  • Management of acute severe asthma in adults in A&E: PEF >75% predicted Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 60 min 15-30 min Clinically stable AND PEF >75% Give usual bronchodilator 5 min PEF >75% best or predicted: mild POTENTIAL DISCHARGE 120 min Measure PEF and arterial saturations Time
  • Management of acute severe asthma in adults in A&E: PEF 33-75% predicted Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 features of severe asthma
    • PEF <50% best of predicted
    • Respiration  25/min
    • Pulse  110 breaths/min
    • Cannot complete sentence in one breath
    Life threatening features OR PEF <50% Clinically stable AND PEF <75% No life threatening features AND PEF 50-75% 15-30 min Clinically stable AND PEF >75% Give salbutamol 5mg by oxygen-driven nebuliser 5 min PEF 33-75% best/predicted: moderate/severe Measure PEF and arterial saturations Time
    • High concentration oxygen (>60% if possible)
    • Give salbutamol 5mg plus ipratropium 0.5mg via oxygen-driven nebuliser
    • AND prednisolone 40-50mg orally or IV hydrocortisone 100mg
    IMMEDIATE MANAGEMENT
  • Management of acute severe asthma in adults in A&E: PEF 33-75% predicted Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 PEF 33-75% best/predicted: moderate/severe Measure PEF and arterial saturations Time Patient recovering AND PEF >75% No signs of severe asthma AND PEF 50-70% Repeat salbutamol 5mg nebuliser Give prednisolone 40-50mg orally Signs of severe asthma OR PEF <50% Life threatening features OR PEF <50% Clinically stable AND PEF <75% No life threatening features AND PEF 50-75% 60 min 15-30 min Clinically stable AND PEF >75% IMMEDIATE MANAGEMENT
    • Give/repeat salbutamol 5mg with ipratropium 0.5mg by oxygen-driven nebuliser after 15 minutes
    • Consider continuous salbutamol nebuliser 5-10mg/hr
    • Consider IV magnesium sulphate 1.2-2g over 20 minutes
    • Correct fluid/electrolytes, especially K + disturbances
    • Chest X-ray
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in A&E: PEF 33-75% predicted
    • Give/repeat salbutamol 5mg with ipratropium 0.5mg by oxygen-driven nebuliser after 15 minutes
    • Consider continuous salbutamol nebuliser 5-10mg/hr
    • Consider IV magnesium sulphate 1.2-2g over 20 minutes
    • Correct fluid/electrolytes, especially K + disturbances
    • Chest X-ray
    ADMIT Patient should be accompanied by a nurse or doctor at all times Signs of severe asthma OR PEF <50% Patient stable AND PEF >50% OBSERVE monitor SpO 2 , heart rate and respiratory rate Patient recovering AND PEF >75% No signs of severe asthma AND PEF 50-70% Signs of severe asthma OR PEF <50% 60 min 15-30 min Clinically stable AND PEF >75% POTENTIAL DISCHARGE 120 min PEF 33-75% best/predicted: moderate/severe Measure PEF and arterial saturations Time
  • Management of acute severe asthma in adults in A&E: PEF <33% predicted Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • High concentration oxygen (>60% if possible)
    • Give salbutamol 5mg plus ipratropium 0.5mg via oxygen-driven nebuliser
    • AND prednisolone 40-50mg orally or IV hydrocortisone 100mg
    • Normal or raised PaCO 2 (PaCO 2 >4.6 kPa; 35mm Hg)
    • Severe hypoxia (PaO 2 <8 kPa; 60mm Hg)
    • Low pH (or high H + )
    • Correct fluid/ electrolytes, especially K + disturbances
    • Chest X-ray
    Obtain senior/ICU help now if any life-threatening features are present 5 min 15-30 min
    • Consider continuous salbutamol nebuliser 5-10mg/hr
    • Consider IV magnesium sulphate 1.2-2g over 20 minutes
    • Silent chest, cyanosis, poor respiratory effort
    • Exhaustion, confusion, coma
    Measure arterial blood gases Markers of severity: IMMEDIATE MANAGEMENT
    • Give/repeat salbutamol 5mg with ipratropium 0.5mg by oxygen-driven nebuliser after 15 minutes
    60 min PEF <33% best or predicted OR any life threatening features : ADMIT – Patient should be accompanied by a nurse or doctor at all times 120 min
    • SpO2 <92%
    • Bradycardia, arrhythmia, hypotension
    Measure PEF and arterial saturations Time
  • Management of acute severe asthma in adults in A&E: potential discharge Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • In all patients who received nebulised ß 2 agonists prior to presentation, consider an extended observation period prior to discharge
    • If PEF <50% on presentation, prescribe prednisolone 40-50mg/day for 5 days
    • In all patients ensure treatment supply of inhaled steroid and ß 2 agonist and check inhaler technique
    • Arrange GP follow up for 2 days post presentation
    • Fax discharge letter to GP
    • Refer to asthma liaison nurse/chest clinic
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in hospital: assessment of PEF
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in hospital Caution: Patients with severe attacks may not be distressed and may not have all these abnormalities. The presence of any should alert the doctor. FEATURES OF ACUTE SEVERE ASTHMA
    • Peak expiratory flow (PEF) 33-50% of best (use % predicted if recent best unknown)
    • Cannot complete sentences in one breath
    • Respirations  25 breaths/min
    • Pulse  110 beats/min
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in hospital Caution: Patients with life threatening attacks may not be distressed and may not have all these abnormalities. The presence of any should alert the doctor. LIFE THREATENING FEATURES
    • PEF <33% of best or predicted
    • SpO 2 <92%
    • Silent chest, cyanosis or feeble respiratory effort
    • Bradycardia, dysrhythmia or hypotension
    • Exhaustion, confusion or coma
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in hospital BLOOD GAS MARKERS OF A LIFE THREATENING ATTACK
    • Blood gas markers of a life threatening attack:
    • Normal (4.6-6kPa, 35-45mm Hg) PaCO 2
    • Severe hypoxia: PaO 2 <8 kPa (60mm Hg) irrespective of treatment with oxygen
    • A low pH (or high H + )
    If a patient has any life threatening feature, measure arterial blood gases. No other investigations are needed for immediate management
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in hospital
    • Raised PaCO 2
    • Requiring IPPV with raised inflation pressures
    NEAR FATAL ASTHMA
  • Management of acute severe asthma in adults in hospital Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Discuss with senior clinician and ICU team
    • Add IV magnesium sulphate 1.2-2g infusion over 20 minutes (unless already given)
    • Give nebulised ß 2 agonist more frequently e.g. salbutamol 5mg up to every 15-30 minutes or 10mg continuously hourly
    IF LIFE THREATENING FEATURES ARE PRESENT:
    • Oxygen 40-60% (CO 2 retention is not usually aggravated by oxygen therapy in asthma)
    • Salbutamol 5mg or terbutaline 10mg via an oxygen-driven nebuliser
    • Ipraptropium bromide 0.5mg via an oxygen-driven nebuliser
    • Prednisolone tablets 40-50mg or IV hydrocortisone 100mg or both if very ill
    • No sedatives of any kind
    • Chest radiograph only if pneumothorax or consolidation are suspected or patient requires IPPV
    IMMEDIATE TREATMENT
  • Management of acute severe asthma in adults in hospital Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 IF PATIENT IS STILL NOT IMPROVING:
    • Discuss patient with senior clinician and ICU team
    • IV magnesium sulphate 1.2-2g over 20 minutes (unless already given)
    • Senior clinician may consider use of IV ß 2 agonist or IV aminophylline or progression to IPPV
    • Continue oxygen and steroids
    • Give nebulised ß 2 agonist more frequently e.g. salbutamol 5mg up to every 15-30 minutes or 10mg continuously hourly
    • Continue ipratropium 0.5mg 4-6 hourly until patient is improving
    IF PATIENT NOT IMPROVING AFTER 15-30 MINUTES:
    • 40-60% oxygen
    • Prednisolone 40-50mg daily or IV hydrocortisone 100mg 6 hourly
    • Nebulised ß 2 agonist and ipratropium 4-6 hourly
    IF PATIENT IS IMPROVING continue: SUBSEQUENT MANAGEMENT IMMEDIATE TREATMENT
  • Management of acute severe asthma in adults in hospital Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Deteriorating PEF, worsening or persisting hypoxia, or hypercapnea
    • Exhaustion, feeble respiration, confusion or drowsiness
    • Coma or respiratory arrest
    Transfer to ICU accompanied by a doctor prepared to intubate if:
    • Repeat measurement of PEF 15-30 minutes after starting treatment
    • Oximetry: maintain SpO 2 >92%
    • Repeat blood gas measurements within 2 hours of starting treatment if: - initial PaO 2 <8 kPa (60mmHg) unless subsequent SpO 2 >92% - PaCO 2 normal or raised - patient deteriorates
    • Chart PEF before and after giving ß 2 agonists and at least 4 times daily throughout hospital stay
    MONITORING SUBSEQUENT MANAGEMENT IMMEDIATE TREATMENT
  • Management of acute severe asthma in adults in hospital Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Determine reason(s) for exacerbation and admission
    • Send details of admission, discharge and potential best PEF to GP
    MONITORING Patients with severe asthma (indicated by need for admission) and adverse behavioural or psychosocial features are at risk of further severe or fatal attacks
    • Been on discharge medication for 24 hours and have had inhaler technique checked and recorded
    • PEF >75% of best or predicted and PEF diurnal variability <25% unless discharge is agreed with respiratory physician
    • Treatment with oral and inhaled steroids in addition to bronchodilators
    • Own PEF meter and written asthma action plan
    • GP follow up arrangement within 2 working days
    • Follow up appointment in respiratory clinic within 4 weeks
    When discharged from hospital, patients should have: DISCHARGE SUBSEQUENT MANAGEMENT IMMEDIATE TREATMENT
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Referral and admission of adults with acute asthma Admit patients with any feature of a life threatening or near fatal attack, or severe attack persisting after initial treatment B
    • still have significant symptoms
    • concerns about compliance
    • living alone/socially isolated
    • psychological problems
    • physical disability or learning difficulties
    • previous near fatal or brittle asthma
    • exacerbation despite adequate dose steroid tablets pre-presentation
    • presentation at night
    • pregnancy
    C Refer to hospital any patients with features of acute severe or life threatening asthma D Discharge from A&E patients with PEF >75% best or predicted 1 hour after initial treatment, unless:
  • Oxygen treatment for acute asthma in adults Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Give high flow oxygen to all patients with acute severe asthma C Whilst supplemental oxygen is recommended, its absence should not prevent nebulised therapy being given if indicated C
    • In hospital, ambulance and primary care, nebulised  2 agonist bronchodilators should be driven by oxygen
    • Outside hospital, high dose  2 agonist bronchodilators may be delivered via spacer or nebuliser
    A
  • ß 2 -agonist bronchodilators for acute asthma in adults Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 In severe/poorly responsive asthma, consider continuous nebulisation A Use high dose inhaled  2 agonists first line in acute asthma given as early as possible, with IV  2 agonists if inhaled therapy cannot be used reliably A Use oxygen driven nebuliser in acute life threatening asthma 
  • Steroids and other therapy for acute asthma in adults Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Routine prescription of antibiotics is not indicated for acute asthma B IV magnesium sulphate (1.2-2 g IV infusion over 20 minutes) and IV aminophylline should only be used following consultation with senior medical staff  Consider IV magnesium sulphate for patients with poorly responding acute severe or life threatening asthma A Nebulised ipratropium bromide (0.5mg 4-6 hourly) should be added to  2 agonist treatment if poor response to  2 agonist therapy A Give steroid tablets in adequate doses in all cases of acute asthma A Continue prednisolone 40-50mg daily for at least 5 days or until recovery 
  • Monitoring of adults with acute asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Measure and record PEF 15-30 minutes after starting treatment, and before/after  2 agonist bronchodilator (at least four times daily) until controlled
    • Record oxygen saturation by oximetry and maintain arterial SaO 2 >92%.
    • Repeat measurements of blood gas tensions within 2 hours of starting treatment if:
    • - the initial PaO 2  8 kPa unless SaO 2  92%; or
    • - the initial PaCO 2 is normal or raised; or
    • - the patient’s condition deteriorates or not improved by 4-6 hours
    • Measure and record heart rate
    • Measure serum potassium and blood glucose concentrations
    • Measure serum theophylline concentration if aminophylline continued for >24 hours (target 55-110  mol/l)
  • Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Patients requiring ventilatory support
    • Patients with poorly responsive severe acute or life threatening asthma shown by:
    • - deteriorating PEF
    • - persisting or worsening hypoxia
    • - hypercapnea
    • - arterial blood gas analysis showing fall in pH or rising H + concentration
    • - exhaustion, feeble respiration
    • - drowsiness, confusion
    • - coma or respiratory arrest
    Referral of adults with acute asthma to intensive care All patients transferred to intensive care units should be accompanied by a doctor suitably equipped and skilled to intubate if necessary C
  • Hospital discharge and follow up after acute asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • GP review within 48 hours
    • Monitor symptoms and PEF
    • Check inhaler technique
    • Written asthma action plan
    • Modify treatment according to guidelines for chronic persistent asthma
    • Address factors that could have contributed to admission
    The patient’s primary care practice must be informed (by fax/ e-mail) within 24 hours of discharge from A&E/hospital after asthma exacerbation, ideally directly with named individual responsible for asthma care 
  • Overview: Management of acute asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92
    • Assess and act promptly in acute asthma
    • Admit patients with any feature of a life threatening or near fatal attack, or severe attack persisting after initial treatment
    • Measure oxygen saturation
    • Use steroid tablets
    • Primary care follow up required promptly after acute asthma