Acute Asthma

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Summary of practice points

 Level of evidence
Managing acute asthma in adults
If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination. [√]
Assess response to treatment using spirometry, oxygen saturation, heart rate, respiratory rate and pulsus paradoxus status. [√]
Wheeze is an unreliable indicator of the severity of an asthma attack and may be absent in severe asthma. [√]
Ensure every patient receives adequate follow-up after an acute asthma episode, including review of medications, triggers and asthma action plan. [√]
Managing acute asthma in children
If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination. [√]
Emergency management of acute asthma in a child is based on initial administration of salbutamol 4-6 puffs (< 6 years) or 8-12 puffs (≥6 years) via MDI. I
Load the spacer with one puff at a time and give each puff separately. III-1
If treatment with an oral corticosteroid (e.g. prednisolone 1 mg/kg up to 60 mg as a single daily dose) has been initiated for a moderate-to-severe acute episode, continue for up to 5 days. I 

This chapter deals with the management of acute asthma in the hospital or emergency facility setting.

For information on community-based management of acute or subacute worsening of symptom control and lung function, see Managing Exacerbations.