Moderate acute asthma in general practice

moderate acute asthma in general practice

On assessment:

• PEF >50–75% best or predicted
• SpO2 ≥92%
• speech normal
• has a pulse rate of <110 beats/min
• respiratory rate <25 breaths/min

Management:

• patients can be managed at home or in surgery
• assess response to treatment.

Treatment:

• β2 bronchodilator:
  • via spacer (give 4 puffs initially and give a further 2 puffs every 2 minutes according to response up to maximum of 10 puffs)
• if PEF >50–75% predicted/best:
  • nebuliser (preferably oxygen driven) (salbutamol 5 mg)
  • give prednisolone 40–50 mg
  • continue or increase usual treatment

If good response to first treatment (symptoms improved, respiration and pulse settling and PEF >50%) continue or increase usual treatment and continue prednisolone.

Admit to hospital if any:

• life threatening features
• features of acute severe asthma present after initial treatment
• previous near fatal asthma

Lower threshold for admission if afternoon or evening attack, recent nocturnal symptoms or hospital admission, previous severe attacks, patient unable to assess own condition, or concern over social circumstances

Reference:

• (1) British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2016. British Guideline on the Management of Asthma. A national clinical guideline