Initial Management Plan for Bronchial Asthma

Assessment and Classification

The American Thoracic Society recommends assessing severity of asthma based on symptoms, peak expiratory flow (PEF), and response to previous treatment 3
Asthma can be classified as mild, moderate, or severe based on clinical features, with severe asthma characterized by inability to complete sentences in one breath, respirations >25/min, pulse >110 beats/min, and PEF <50% of predicted 4
Life-threatening asthma is characterized by PEF <33% of predicted, silent chest, cyanosis, bradycardia, hypotension, exhaustion, confusion, or coma 3

The British Medical Association recommends starting with inhaled corticosteroids (up to 800 μg/day equivalent of beclomethasone) as the primary anti-inflammatory therapy for mild to moderate persistent asthma 2
The American Academy of Family Physicians recommends prescribing short-acting inhaled beta2-agonist (e.g., salbutamol) as needed for symptom relief 1
For acute severe asthma, the British Thoracic Society recommends administering oxygen 40-60%, nebulized salbutamol 5-10 mg or terbutaline 5-10 mg via oxygen-driven nebulizer, and oral prednisolone 30-60 mg or intravenous hydrocortisone 200 mg 3, 4

The British Thoracic Society recommends measuring PEF before and after bronchodilator administration to assess response, and maintaining oxygen saturation >92% using pulse oximetry 3
The American Academy of Family Physicians recommends scheduling follow-up within one week with primary care physician after any acute episode, and arranging follow-up with respiratory specialist within 4 weeks if hospitalized 5

The British Medical Association recommends providing a written asthma action plan detailing when to increase treatment, when to seek medical help, and how to adjust medications based on symptoms and PEF readings 2, 5, 1
The British Thoracic Society recommends prescribing a peak flow meter and teaching proper technique, and educating about proper inhaler technique and checking at each visit 5

The British Medical Association recommends starting with metered dose inhaler (MDI) for most patients, and adding large volume spacer if patient has difficulty using MDI alone 2

The British Thoracic Society recommends avoiding sedatives in patients with asthma attacks, and considering chest radiograph to exclude pneumothorax in severe cases 3
For children, the British Thoracic Society recommends adjusting medication doses appropriately (half doses of nebulized medications for very young children) 3

The British Thoracic Society recommends being aware of underestimating severity, inadequate follow-up, poor inhaler technique, overreliance on bronchodilators, and failure to provide a written action plan 3, 5, 1