puffs every two minutes up to a maximum
of 10 puffs. A further option is to administer
ipratropium bromide 0.5mg in addition
to further beta2 agonists. If a patient
does not respond to initial treatment, an
ambulance should be called.
Many patients with acute severe asthma
are hypoxic so pulse oximetry is an essential
part of assessment (BTS and SIGN,
2012). Hypoxia should be managed with
supplemental oxygen administered via a
face mask, venturi mask or nasal cannula,
with flow rates adjusted to maintain an
SpO2 of 94-98%. Nebulisers should be
driven by oxygen, as there is a risk of desaturation
when using air-driven devices
(BTS and SIGN, 2012).
Some clinicians may choose to administer
bronchodilators by nebuliser. However,
BTS and SIGN (2012) advise using a
pMDI and spacer for moderate exacerbations,
and nebulisers for acute severe
asthma and life-threatening asthma
(although pMDIs and spacers can also be
used in these circumstances).
As a general rule, patients with an acute
asthma exacerbation should be assessed,
given initial treatment in the form of bronchodilators
administered via pMDI and a
spacer, and given oxygen if they are
hypoxic. They should be considered for
hospital admission if unresponsive to initial
treatment or if they have any features
of acute, severe or life-threatening asthma.
Admission should also be considered if:
puffs every two minutes up to a maximumof 10 puffs. A further option is to administeripratropium bromide 0.5mg in additionto further beta2 agonists. If a patientdoes not respond to initial treatment, anambulance should be called.Many patients with acute severe asthmaare hypoxic so pulse oximetry is an essentialpart of assessment (BTS and SIGN,2012). Hypoxia should be managed withsupplemental oxygen administered via aface mask, venturi mask or nasal cannula,with flow rates adjusted to maintain anSpO2 of 94-98%. Nebulisers should bedriven by oxygen, as there is a risk of desaturationwhen using air-driven devices(BTS and SIGN, 2012).Some clinicians may choose to administerbronchodilators by nebuliser. However,BTS and SIGN (2012) advise using apMDI and spacer for moderate exacerbations,and nebulisers for acute severeasthma and life-threatening asthma(although pMDIs and spacers can also beused in these circumstances).As a general rule, patients with an acuteasthma exacerbation should be assessed,given initial treatment in the form of bronchodilatorsadministered via pMDI and aspacer, and given oxygen if they arehypoxic. They should be considered forhospital admission if unresponsive to initialtreatment or if they have any featuresof acute, severe or life-threatening asthma.Admission should also be considered if:
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