| Mild–moderately severe | Severe | Life-threatening | |
| Assessment | All of: Can walk, speak whole sentences in one breath SpO2 (room air) >94% | Any of: Unable to complete sentences in one breath due to breathlessness Use of accessory muscles of neck or intercostal muscles/tracheal tug/subcostal recession during inspiration Obvious respiratory distress SpO2 (room air) ≤94% | Any of: Reduced consciousness/collapse, exhaustion Cyanosis Poor respiratory effort SpO2 (room air) <92% Poor respiratory effort, soft/absent breath sounds
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| Triage | Manage in place | Arrange transfer to acute care | |
Immediate treatment | Give salbutamol 4–12 actuations (100 microg per actuation) via pMDI and spacer (tidal breathing method) | Give salbutamol 12 actuations (100 microg per actuation) via pMDI and spacer (tidal breathing). If patient cannot use spacer, 5 mg salbutamol nebule via nebuliser (if available) Start oxygen supplementation if SpO2 (room air) <92%.* Titrate to target SpO2 92–96% | Without nebuliser: Give salbutamol 12 actuations (100 microg per actuation) via pMDI and spacer ± mask (tidal breathing). With nebuliser: Give salbutamol 2 x 5 mg nebules via continuous nebulisation driven by oxygen: SpO2 target 92–96%* |
| Continued treatment | Repeat salbutamol 4–12 actuations every 20–30 minutes for the first hour, if needed (sooner if needed) | Repeat salbutamol 12 actuations at least every 20 minutes for first hour (3 doses) | Maintain SpO2 to target 92–96%* |
Additional information
SpO2: oxygen saturation measured by pulse oximetry; *88–92% for patients at risk of hypercapnoea