Initial Treatment for Asthma Patient with Mucous Plugging and Ground-Glass Opacities
Immediate Management
- The British Thoracic Society recommends administering high-flow oxygen (40-60%) via face mask to maintain oxygen saturation >92% 2, 3
- The British Thoracic Society suggests giving nebulized salbutamol 5-10 mg or terbutaline 10 mg via oxygen-driven nebulizer 1, 4
- The British Thoracic Society recommends administering systemic corticosteroids: either oral prednisolone 30-60 mg or intravenous hydrocortisone 200 mg (or both if patient is very ill) 1, 2
- Consider adding ipratropium bromide 0.5 mg to the nebulizer if the patient is not improving after 15-30 minutes 1, 4
- Obtain a chest radiograph to exclude pneumothorax and confirm the ground-glass opacities 1, 2
Monitoring and Assessment
- Measure peak expiratory flow (PEF) 15-30 minutes after starting treatment 2
- Use pulse oximetry to maintain SaO₂ >92% 2, 3
- Consider arterial blood gas measurement if PaO₂ <8 kPa (60 mm Hg) initially, PaCO₂ was normal or raised initially, or patient shows clinical deterioration 1, 2
- Chart PEF before and after nebulized treatments 2
Subsequent Management
- If patient is improving, continue oxygen therapy, prednisolone 30-60 mg daily or intravenous hydrocortisone, and nebulized beta-agonist every 4-6 hours 1, 2, 4
- If patient is not improving after 15-30 minutes, increase frequency of nebulized beta-agonist, add ipratropium bromide 0.5 mg to nebulizer, and consider admission to hospital 1, 2, 4
Criteria for ICU Transfer
- Transfer the patient to intensive care unit if there is deteriorating PEF, worsening or persistent hypoxia, confusion or drowsiness, or exhaustion, coma, or respiratory arrest 1, 2
Discharge Criteria
- Patients should only be discharged when they have been on discharge medication for 24 hours, have PEF >75% of predicted or best with variability <25%, and have follow-up arranged with primary care within 1 week 1, 2