Asthma Management Guidelines
Zone Classification and Management
- The British Thoracic Society recommends that patients with a peak expiratory flow (PEF) >75% of predicted or personal best be classified as having mild asthma, with normal speech, pulse <110 beats/min, and respiratory rate <25 breaths/min 2, 3, 4
- For patients with moderate asthma (PEF 50-75% of predicted or personal best), the British Medical Journal suggests increasing albuterol use, adding prednisolone 30-60 mg, and monitoring response 15-30 minutes after treatment 2
- The British Thoracic Society recommends that patients with severe asthma (PEF <50% of predicted or personal best) receive immediate nebulized salbutamol 5 mg or terbutaline 10 mg with oxygen, and consider hospital admission if multiple features are present 4, 5, 6
- For life-threatening asthma exacerbations (PEF <33% of predicted or personal best), the British Medical Journal recommends immediate oxygen 40-60%, nebulized salbutamol 10 mg or terbutaline 5 mg, and consideration of hospital admission with potential ICU transfer 5, 6
Monitoring and Follow-up
- The British Thoracic Society recommends measuring PEF 15-30 minutes after starting treatment, maintaining oxygen saturation >92%, and charting PEF before and after bronchodilator administration 5, 7
- For discharge criteria, the British Thoracic Society suggests that patients should have a PEF >75% of predicted or personal best with diurnal variability <25%, be on discharge medication for 24 hours with inhaler technique checked, and have a written self-management plan 5, 8
Common Pitfalls to Avoid
- The British Medical Journal warns against underestimating severity, delaying corticosteroid administration, using sedatives during asthma exacerbations, and failing to provide patients with a written action plan based on peak flow zones 1, 2, 3
- The British Thoracic Society emphasizes the importance of checking inhaler technique before discharge to ensure effective home treatment 5, 8