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Acute Asthma Exacerbation: Treatment according to Severity of Symptoms

for Health Care Providers

Table 2: Acute Asthma Exacerbation: Treatment according to Severity of Symptoms

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SeveritySigns and SymptomsTreatment
Mild
  • Dyspnea with activity
or
  • PEFR ≥80% personal best/predicted
  • Can be managed at home
  • SABA
  • Possible short course of oral systemic corticosteroids (5 days)
Moderate
  • Dyspnea limits usual activity
or
  • PEFR 60-80% personal best/predicted
  • Usually requires emergency department or office visit
  • Frequent SABA
  • Reassess after 1-2 hours; a good response includes a normal exam, no distress, PEFR>70%, O2 saturation >90%, and a sustained response for 60 minutes after the last treatment
  • Oral steroids (40-80 mg QD) until PEFR >70% personal best/predicted
Severe
  • Dyspnea at rest, or lack or response to treatments for moderate-severity acute asthma
or
  • PEFR <60% personal best/predicted
  • Usually requires emergency department or office visit
  • Frequent nebulized SABA with reassessments
  • Oral steroids (40-80 mg QD) until PEFR >70% personal best/predicted
Life Threatening
  • Too dyspneic to speak, drowsy or confused
  • Requires emergency department visit, usually hospitalization
  • Nebulized SABA and ipratropium hourly or continuous
  • PO or IV steroids
  • Consider magnesium sulfate infusion (2 g), heliox delivered albuterol
  • Consider intubation in patients with persistent hypercapnia, exhaustion, depressed mental status

From Asthma
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009