Asthma
Asthma Exacerbation Home Management
search
Asthma Exacerbation Home Management
, Asthma Action Plan
See Also
Asthma Exacerbation
Asthma Education
Asthma Management
Emergency Management of Asthma Exacerbation
Asthma Inpatient Management
Status Asthmaticus
Asthma-Related Death Risk Factors
Asthma Differential Diagnosis
Contraindications
Patients who require immediate medical attention (home management protocol no recommended)
High risk of fatal
Asthma
attack
See
Asthma-Related Death Risk Factors
Serious exacerbation signs and symptoms
Significant breathlessness
Unable to speak in short phrases
Accessory
Muscle
use
Lethargy
Peak Expiratory Flow
<50%
Management
Step 1 -
Inhaled Beta Agonist
(e.g.
Albuterol
)
Albuterol
Trial
Up to 2 treatments of
Albuterol
MDI 2-6 puffs each (with 20 minutes interval between each use) OR
One treatment of
Albuterol Nebulizer
Reassessment after 1 hour
Management
Step 2a - Good Response (Mild) with PEF>80%
Signs
No
Wheezing
,
Dyspnea
or
Tachypnea
Sustained response to
Albuterol
for 4 hours
Home Management
Albuterol
2-4 puffs q3-4 hours for 24-48 hours
Inhaled Corticosteroid
if already using
Double dose for 7-10 days
Increased dosing has variable efficacy for acute exacerbation
Consider oral
Corticosteroid
s
Contact medical provider in 48 hours for further management
Management
Step 2b - Incomplete Response (Moderate) with PEF 50-79%
Signs
Persistent
Wheezing
Shortness of Breath
Tachypnea
Cough
Chest
Tightness
Home Management
Albuterol
2-4 puffs q3-4 hours for 24-48 hours
Oral
Corticosteroid
Adult
Prednisone
40-60 mg per day divided daily to twice daily for 3-10 days OR
Depo-Medrol 160 mg IM for single dose
Equal
to
Methylprednisolone
160 mg PO x8 days
Effect may be delayed 48 hours
Child
Prednisolone
Dose: 1-2 mg/kg/day to maximum 60 mg/day for 3-10 days OR
Dexamethasone
Dose: 0.3 to 0.6 mg/kg/day PO/IV/IM up to 15 mg for 1-2 days
Keeney (2014) Pediatrics 133(3): 493-9 [PubMed]
No tapering needed if use less than 2 weeks
Continue course until
Peak Expiratory Flow
>70%
Contact medical provider urgently same day for recommendations
Management
Step 2c - Poor Response (Severe) with PEF <50%
Signs
Marked
Wheezing
Shortness of Breath
,
Cough
or
Chest
Tightness
Severe distress
Inhaled
Albuterol
effect lasts less than 2 hours
Immediate Management
Albuterol
Inhaler
4-6 puffs every 20 minutes prn
Start oral
Corticosteroid
s
Adult: 40 to 60 mg per day divided qd to bid
Child (choose one)
Prednisolone
1-2 mg/kg/day to maximum 60 mg/day for 3-10 days
No tapering needed if use less than 2 weeks
Dexamethasone
Dose: 0.3 to 0.6 mg/kg/day PO/IV/IM up to 15 mg for 1-2 days
Keeney (2014) Pediatrics 133(3): 493-9 [PubMed]
Pursue immediate medical care
Contact doctor
Proceed to Emergency Department
Call 911
References
Pollart (2011) Am Fam Physician 84(1): 40-7 [PubMed]
(1997) Management of
Asthma
, NIH 97-4053
(1995) Global Strategy for
Asthma
, NIH 95-3659
Stoloff (1997) Am Fam Physician 56(1):117-26 [PubMed]
Type your search phrase here