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Acute severe asthma in general practice

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

On assessment:

  • PEF 33–50% best or predicted
  • SpO2 ≥92%
  • cannot speak in completed sentences
  • has a pulse rate of ≥110 beats/min
  • respiratory rate ≥25 breaths/min


  • serious consideration for immediate admission if more than one feature of the above present.


  • give oxygen to maintain SpO2 94–98% if available
  • β2 bronchodilator:
    • nebuliser (preferably oxygen driven) (salbutamol 5 mg)
    • or via spacer (give 4 puffs initially and give a further 2 puffs every 2 minutes according to response up to maximum of 10 puffs)
  • oral prednisolone 40–50 mg or IV hydrocortisone 100 mg

Monitor response 15-30 minutes after nebuliser therapy.

If any signs of acute severe asthma persist then arrange hospital admission.

  • remain with patient until ambulance arrives
  • send written asssessment and referral details to hospital
  • β2 bronchodilator via oxygen-driven nebuliser in ambulance (1)


  • monitoring of symptoms and PEF
  • give self management plan
  • review at GP surgery in <= 24 hours

At review, modify treatment according to guidelines for chronic persistent asthma.


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