Managing acute asthma in clinical settings
- Wheezing infants younger than 12 months old should not be treated for acute asthma. Acute wheezing in this age group is most commonly due to acute viral bronchiolitis.
Advice should be obtained from a paediatric respiratory physician or paediatrician before administering short-acting beta2 agonists, systemic corticosteroids or inhaled corticosteroids to an infant.
Acute asthma management in children, adolescents and adults is based on:
- assessing severity (mild/moderate, severe or life-threatening) while starting bronchodilator treatment immediately
- administering oxygen therapy if peripheral capillary oxygen saturation measured by pulse oximetry (SpO2) is less than 92% in adults or less than 95% in 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 has been transferred to an intensive care unit or admitted to hospital
- observing the patient for at least 3 hours after respiratory distress or increased work of breathing has resolved
- providing post-acute care and arranging follow-up to reduce the risk of future flare-ups.
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
Notes: The classification of acute asthma severity differs between clinical settings. The definitions of mild/moderate, severe and life-threatening acute asthma used in this handbook may differ from those of some published clinical trials and other guidelines.
The terms ‘exacerbation’, ‘flare-up’, ‘attack’ and ‘acute asthma’ are used differently by patients and clinicians, and in different contexts.
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 described 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