for Health Care Providers

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

Severity	Signs and Symptoms	Treatment
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