British Guideline on the Management of Asthma

1
The British Thoracic Society Scottish
Intercollegiate Guidelines Network
Management ofacute asthma
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Patients at risk of developingnear fatal or
fatal asthma
Recognised by combination of
and
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Patients at risk of developingnear fatal or
fatal asthma
Recognised by combination of
and
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Patients at risk of developingnear fatal or
fatal asthma
Recognised by combination of
and
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Lessons learnt fromstudies of asthma deaths

• Many deaths from asthma are preventable 88-92
  of attacks requiring
• hospitalisation develop over ?6 hours
• Factors include
• inadequate objective monitoring
• failure to refer earlier for specialist advice
• inadequate treatment with steroids

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Levels of severity ofacute asthma exacerbations
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Levels of severity ofacute asthma exacerbations
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Levels of severity ofacute asthma exacerbations
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Levels of severity ofacute asthma exacerbations
Management of acute asthma. Thorax 2003 58
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Levels of severity ofacute asthma exacerbations
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Initial assessment the role of symptoms, signs
and measurements
Management of acute asthma. Thorax 2003 58
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Initial assessment the role of symptoms, signs
and measurements
Management of acute asthma. Thorax 2003 58
(Suppl I) i1-i92
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Initial assessment the role of symptoms, signs
and measurements
Management of acute asthma. Thorax 2003 58
(Suppl I) i1-i92
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Initial assessment the role of symptoms, signs
and measurements
Management of acute asthma. Thorax 2003 58
(Suppl I) i1-i92
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Initial assessment the role of symptoms, signs
and measurements
Management of acute asthma. Thorax 2003 58
(Suppl I) i1-i92
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Initial assessment the role of symptoms, signs
and measurements
Management of acute asthma. Thorax 2003 58
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Assessment and management of acute asthma in
adults in general practice
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Assessment and management of acute asthma in
adults in general practice
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Assessment and management of acute asthma in
adults in general practice
Caution Patients with severe or life threatening
attacks may not be distressed and may not have
all the abnormalities listed. The presence of
any should alert the doctor.
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Assessment and management of acute asthma in
adults in general practice
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Treatment of acute asthmain adults in general
practice
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Acute asthma in adults in general practice
admission to hospital
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Management of acute severe asthma in adults in
AE assessment of PEF
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Management of acute severe asthma in adults in
AE PEF gt75 predicted
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Management of acute severe asthmain adults in
AE PEF 33-75 predicted
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Management of acute severe asthmain adults in
AE PEF 33-75 predicted
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Management of acute severe asthmain adults in
AE PEF 33-75 predicted
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Management of acute severe asthma in adults in
AE PEF lt33 predicted
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Management of acute severe asthma in adults in
AE potential discharge
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Management of acute severe asthma in adults in
hospital assessment of PEF
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Management of acute severeasthma in adults in
hospital
Caution Patients with severe attacks may not be
distressed and may not have all these
abnormalities. The presence of any should alert
the doctor.
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Management of acute severeasthma in adults in
hospital
Caution Patients with life threatening attacks
may not be distressed and may not have all these
abnormalities. The presence of any should alert
the doctor.
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Management of acute severeasthma in adults in
hospital
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Management of acute severeasthma in adults in
hospital
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Management of acute severeasthma in adults in
hospital
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Management of acute severeasthma in adults in
hospital
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Management of acute severeasthma in adults in
hospital
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Management of acute severeasthma in adults in
hospital
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Referral and admission ofadults with acute asthma
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Oxygen treatment foracute asthma in adults
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ß2-agonist bronchodilatorsfor acute asthma in
adults
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Steroids and other therapyfor acute asthma in
adults
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Monitoring of adults withacute asthma
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Referral of adults with acuteasthma to intensive
care

• Patients requiring ventilatory support
• Patients with poorly responsive severe acute or
  life threatening asthma shown by
• - deteriorating PEF
• - persisting or worsening hypoxia
• - hypercapnea
• - arterial blood gas analysis showing fall in pH
  or rising H concentration
• - exhaustion, feeble respiration
• - drowsiness, confusion
• - coma or respiratory arrest

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Initial assessment of acute asthma in children
aged gt2 years in general practice
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Management of acute asthma inchildren aged gt2
years in general practice
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Response to treatment of acute asthma in children
aged gt2 years in general practice
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Initial assessment of acute asthma in children
aged gt2 years in AE
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Management of acute asthmain children aged gt2
years in AE
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Response to treatment of acute asthmain children
aged gt2 years in AE
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Initial assessment of acute asthma in children
aged gt2 years in hospital
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Management of acute asthma inchildren aged gt2
years in hospital
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Response to treatment of acute asthma in children
aged gt2 years in hospital
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Treatment of acute asthmain children aged gt2
years
Dose can be repeated every 20-30 minutes
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Steroid therapy for acuteasthma in children aged
gt2 years
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Other therapies for acuteasthma in children aged
gt2 years
Dose can be repeated every 20-30 minutes
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Hospital admission for acuteasthma in children
aged gt2 years
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Treatment of acute asthmain children aged lt2
years
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Hospital discharge andfollow up after acute
asthma

• GP review within 48 hours
• Monitor symptoms and PEF
• Check inhaler technique
• Written asthma action plan
• Modify treatment according to guidelines for
  chronic persistent asthma
• Address factors that could have contributed to
  admission

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Overview Managementof acute asthma

• Assess and act promptly in acute asthma
• Admit patients with any feature of a life
  threatening or near fatal attack, or severe
  attack persisting after initial treatment
• Measure oxygen saturation
• Use steroid tablets
• Primary care follow up required promptly after
  acute asthma

Management of acute asthma. Thorax 2003 58
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