Asthma Exacerbation Home Management

Aka: Asthma Exacerbation Home Management, Asthma Action Plan

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II. Contraindications: Patients who require immediate medical attention (home management protocol no recommended)

  1. High risk of fatal Asthma attack
    1. See Asthma-Related Death Risk Factors
  2. Serious exacerbation signs and symptoms
    1. Significant breathlessness
    2. Unable to speak in short phrases
    3. Accessory Muscle use
    4. Lethargy
    5. Peak Expiratory Flow <50%

III. Management: Step 1 - Inhaled Beta Agonist (e.g. Albuterol)

  1. Albuterol Trial
    1. Up to 2 treatments of Albuterol MDI 2-6 puffs each (with 20 minutes interval between each use) OR
    2. One treatment of Albuterol Nebulizer
  2. Reassessment after 1 hour

IV. Management: Step 2a - Good Response (Mild) with PEF>80%

  1. Signs
    1. No Wheezing, Dyspnea or Tachypnea
    2. Sustained response to Albuterol for 4 hours
  2. Home Management
    1. Albuterol 2-4 puffs q3-4 hours for 24-48 hours
    2. Inhaled Corticosteroid if already using
      1. Double dose for 7-10 days
      2. Increased dosing has variable efficacy for acute exacerbation
    3. Consider oral Corticosteroids
    4. Contact medical provider in 48 hours for further management

V. Management: Step 2b - Incomplete Response (Moderate) with PEF 50-79%

  1. Signs
    1. Persistent Wheezing
    2. Shortness of Breath
    3. Tachypnea
    4. Cough
    5. Chest Tightness
  2. Home Management
    1. Albuterol 2-4 puffs q3-4 hours for 24-48 hours
    2. Oral Corticosteroid
      1. Adult
        1. Prednisone 40-60 mg per day divided daily to twice daily for 3-10 days OR
        2. Depo-Medrol 160 mg IM for single dose
          1. Equal to Methylprednisolone 160 mg PO x8 days
          2. Effect may be delayed 48 hours
      2. Child
        1. Prednisolone
          1. Dose: 1-2 mg/kg/day to maximum 60 mg/day for 3-10 days OR
        2. Dexamethasone
          1. Dose: 0.3 to 0.6 mg/kg/day PO/IV/IM up to 15 mg for 1-2 days
          2. Keeney (2014) Pediatrics 133(3): 493-9 [PubMed]
      3. No tapering needed if use less than 2 weeks
      4. Continue course until Peak Expiratory Flow >70%
    3. Contact medical provider urgently same day for recommendations

VI. Management: Step 2c - Poor Response (Severe) with PEF <50%

  1. Signs
    1. Marked Wheezing
    2. Shortness of Breath, Cough or Chest Tightness
    3. Severe distress
    4. Inhaled Albuterol effect lasts less than 2 hours
  2. Immediate Management
    1. AlbuterolInhaler 4-6 puffs every 20 minutes prn
    2. Start oral Corticosteroids
      1. Adult: 40 to 60 mg per day divided qd to bid
      2. Child (choose one)
        1. Prednisolone 1-2 mg/kg/day to maximum 60 mg/day for 3-10 days
          1. No tapering needed if use less than 2 weeks
        2. Dexamethasone
          1. Dose: 0.3 to 0.6 mg/kg/day PO/IV/IM up to 15 mg for 1-2 days
          2. Keeney (2014) Pediatrics 133(3): 493-9 [PubMed]
    3. Pursue immediate medical care
      1. Contact doctor
      2. Proceed to Emergency Department
      3. Call 911

VII. References

  1. Pollart (2011) Am Fam Physician 84(1): 40-7 [PubMed]
  2. (1997) Management of Asthma, NIH 97-4053
  3. (1995) Global Strategy for Asthma, NIH 95-3659
  4. Stoloff (1997) Am Fam Physician 56(1):117-26 [PubMed]

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