Asthma: acute severe
Patients with acute severe asthma are stratified into moderate, severe or life-threatening
Note that a patient having any one of the life-threatening features should be treated as having a life-threatening attack.
British Thoracic Society guidelines
| Moderate | Severe | Life-threatening |
|---|---|---|
| PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm | PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm | PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma |
Note that a patient having any one of the life-threatening features should be treated as having a life-threatening attack.
British Thoracic Society guidelines
- magnesium sulphate recommended as next step for patients who are not responding (e.g. 1.2 - 2g IV over 20 mins)
- little evidence to support use of IV aminophylline (although still mentioned in management plans)
- if no response consider IV salbutamol