Acute Exacerbation of Asthma

Signs and Symptoms

Severity of asthma are categorized as follows.

Mild: Audible wheeze, no respiratory distress, feeding well, O2 Saturation >92%

Moderate: Respiratory distress, use of accessory muscles, still feeding well, Saturation >92%

Severe: Marked respiratory distress, too breathless to talk/feed, RR>30 if 5 years and >50 if 2-5 years, Saturation<92%

Treatment

NB: if inhalers and spacers cannot be obtained start with nebulized salbutamol at below mentioned doses and switch to inhaler later.

Mild Asthma

• Salbutamol inhaler vial spacer 2 puffs q6h for 2-3 days
• Discharge with advice on inhaler and spacer technique

Moderate Asthma

• Salbutamol inhaler via spacer; <4y- 5puffs every 20mins x3, >4yrs- 10puffs every 20mins x3
• Prednisolone 1mg/kg (max 30mg q24h) for 3/7

Severe Asthma

• Oxygen at 1-2 L/min over nasal prongs and at least 5 L/min over face mask
• Salbutamol nebulizer (start with 3 back-to-back to start with)
• <4yrs: 2.5mg
• >4yrs: 5mg
• Start steroids if no improvement but still continue Nebulizer
• STEROIDS
• Prednisolone 1-2mg/kg PO STAT- (Max. dose 40mg) OR
• Dexamethasone 0.6mg/kg PO STAT – (max. dose 10mg) OR
• Hydrocortisone IV <5yrs: 50mg; >5yrs:100mg IV STAT
• If no improvement continue Nebulizer but start IV therapy;
• Magnesium Sulphate IV 40mg/kg (diluted to at least 10%) over 20 min OR with caution use
• Aminophylline IV 5mg/kg (max. 300mg) diluted (maximum concentration 25mg/ml) and administered over 20min (maximum rate should not exceed 25mg/min)