• Severity – Severe or Life threatening – think RESUS
• Treatment within 30 min – bronchodilators and steroids should bee given within 30min
• 1hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
• PEFR – must be >75% expected prior to discharge (at least 1hr after treatment finished)
• Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer

Severity Assessment

Treatment

Investigations

Admission/Discharge

Life Threatening Asthma

• Involve Seniors and ICU early 
• Consider IV therapy early
  • IV Magnesium – 2g over 20min
  • IV Salbutamol – BNF here
    • Loading – 250 micrograms, repeated if necessary, injection to be diluted to a concentration of 50 micrograms/mL
    • Infusion – Initially 5 micrograms/minute, adjusted according to response and heart rate, usual dose 3-20 micrograms/minute
  • IV Aminophylline (IV Salbutamol OR Aminophylline not both) – BNF Here
    • Loading – 250–500 mg (max. per dose 5 mg/kg), to be followed by intravenous infusion
    • Infusion (Adult) – 500–700 micrograms/kg/hour, adjusted according to plasma-theophylline concentration.
    • Infusion (Eldery) – 300 micrograms/kg/hour, adjusted according to plasma-theophylline concentration.

Potential Discharges – BTS

BTS: Full Guide here