Asthma Management Guidelines

Introduction to Asthma Management

The British Thoracic Society recommends a stepwise approach to asthma management with the goal of achieving symptom control using the lowest effective medication doses while preventing exacerbations and minimizing side effects 1

Accurate early diagnosis is essential for effective management of asthma 1
Assessment should include objective measurements such as peak expiratory flow (PEF) to avoid underestimating severity 2
Failure to objectively assess severity is a common factor in preventable asthma deaths 2

For mild intermittent asthma, use as-needed short-acting β2-agonists (SABA) for symptom relief 1
For mild intermittent asthma, no regular controller medication is required 1

Life-threatening features of acute asthma exacerbation include PEF <33% of predicted/best, silent chest, cyanosis, poor respiratory effort, bradycardia, hypotension, confusion, exhaustion, or coma 3, 4
Severe features of acute asthma exacerbation include inability to complete sentences in one breath, respiratory rate >25/min, pulse >110/min, PEF <50% of predicted/best 3, 4
High-flow oxygen (40-60%) should be administered in all cases of acute severe asthma 5, 2
Nebulized salbutamol 5 mg or terbutaline 10 mg via oxygen-driven nebulizer should be administered in acute severe asthma 3, 6
Systemic corticosteroids, such as prednisolone 30-60 mg orally or hydrocortisone 200 mg IV, should be administered in acute severe asthma 3, 6

Patients with life-threatening features of acute asthma exacerbation should be admitted to the hospital 6, 5
Patients with features of acute severe asthma persisting after initial treatment should be admitted to the hospital 6, 5
Patients with PEF <33% of predicted/best after treatment should be admitted to the hospital 6, 5

Patients should understand the difference between "relievers" (bronchodilators) and "preventers" (anti-inflammatory medications) 1
A written action plan with clear instructions for medication adjustment should be provided to patients 1
Regular monitoring of symptoms and peak flow is recommended for patients with asthma 6, 1

Children over 5 years can typically use a peak flow meter for monitoring 7
Age-appropriate dosing of salbutamol is 2.5 mg up to age 2 and 5 mg over age 2 7
Patients with catastrophic sudden severe asthma should have a management plan mutually agreed upon by the patient, GP, and consultant 7

Underestimating severity by failing to use objective measurements is a common pitfall in asthma management 2, 1
Overreliance on bronchodilators without adequate anti-inflammatory treatment is a common pitfall in asthma management 1
Delayed administration of systemic corticosteroids during severe exacerbations is a common pitfall in asthma management 1

Regular review of inhaler technique, adherence, and symptom control is recommended 1
Follow-up within 24-48 hours after acute exacerbations is recommended 6, 1
Consider stepping down treatment when stable for 3 months 1
Monitor for potential side effects of medications, particularly with higher doses of inhaled corticosteroids 1