Managing acute asthma in clinical settings
Acute asthma management is based on:
- assessing severity (mild/moderate, severe or life-threatening) while starting bronchodilator treatment immediately
- administering oxygen therapy, if required, and titrating oxygen saturation to target of 92–95% (adults) or at least 95% (children)
- completing observations and assessments (when appropriate, based on clinical priorities determined by baseline severity)
- administering systemic corticosteroids within the first hour of treatment
- repeatedly reassessing response to treatment and either continuing treatment or adding on treatments, until acute asthma has resolved, or patient is transferred to an intensive care unit or admitted to hospital
- observing the patient for at least 1 hour after dyspnoea/respiratory distress has resolved, providing post-acute care and arranging follow-up.
Figure. Managing acute asthma in adults Please view and print this figure separately: http://www.asthmahandbook.org.au/figure/show/65
Figure. Managing acute asthma in children Please view and print this figure separately: http://www.asthmahandbook.org.au/figure/show/67
Figure. Initial management of life-threatening acute asthma in adults and children Please view and print this figure separately: http://www.asthmahandbook.org.au/figure/show/94
Note: Definitions of severity classes for acute asthma used in this handbook may differ from those used in published clinical trials and other guidelines that focus on, are or restricted to, the management of acute asthma within emergency departments or acute care facilities. In this handbook, the severity of flare-ups and acute asthma is defined consistently across all Australian clinical settings (including community-based clinics and emergency departments). Accordingly, the classification of flare-ups and the classification of acute asthma overlap (e.g. a flare-up is considered to be at least ‘moderate’ if it is troublesome enough to cause the patient or carers to visit an emergency department or seek urgent treatment from primary care, yet it might be assessed as ‘mild’ acute asthma within acute services).
In this handbook, the categories of ‘mild’ and ‘moderate’ acute asthma have been merged to avoid confusion between terminologies traditionally used at different levels of the health system. Mild acute asthma can usually be managed at home by following the person’s written asthma action plan.
In this section
Completing a rapid primary assessment and starting initial treatment
Giving bronchodilator treatment according to severity and age
Completing secondary assessments and reassessing severity
Starting systemic corticosteroid treatment
Assessing response to treatment
Continuing treatment and considering additional treatment
Providing post-acute care