Initial Treatment for Asthma Crisis
Evaluation and Treatment
- The British Thoracic Society recommends initial treatment for asthma crisis to include high-flow oxygen, salbutamol 5 mg nebulized, and prednisolone 30-60 mg oral or hydrocortisone 200 mg intravenously 1, 2, 3
- The British Thoracic Society suggests that patients with severe asthma should be recognized by signs such as difficulty speaking in complete sentences, respiratory rate >25 breaths/min, peak expiratory flow (PEF) <50% predicted, and heart rate >110 beats/min 4
- Patients with life-threatening signs, such as PEF <33% predicted, silent chest, cyanosis, or weak respiratory effort, should be treated promptly 4
Oxygen Therapy
- The British Medical Association recommends administering high-flow oxygen via mask to maintain SaO2 >92% 3, 5
Bronchodilators
- The British Medical Association suggests salbutamol 5 mg nebulized with oxygen as a first-line treatment for asthma crisis 1, 3
- Alternative treatments include terbutaline 10 mg nebulized or multiple inhalations of salbutamol via metered-dose inhaler (MDI) with spacer (10-20 puffs) 1, 4
Corticosteroids
- The British Medical Association recommends prednisolone 30-60 mg orally or hydrocortisone 200 mg intravenously, especially for severely ill patients 1, 2
Subsequent Management
- If the patient improves, continue oxygen 40-60%, prednisolone 30-60 mg daily, and β-agonist nebulized every 6 hours 2
- If the patient does not improve, continue oxygen and corticosteroids, and administer β-agonist nebulized more frequently (every 15-30 minutes) 2
- Consider adding ipratropium 0.5 mg nebulized and repeating every 6 hours until the patient improves 2, 3
Monitoring
- Repeat PEF measurement 15-30 minutes after initiating treatment 3
- Maintain SaO2 >92% via oximetry 3
- Repeat arterial blood gas analysis within 2 hours if PaO2 <8 kPa (60 mm Hg) or if PaCO2 was initially elevated 3
- Record PEF before and after β-agonist administration 3