Pulmonology Book

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Asthma Exacerbation Home Management

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  1. See Also
    1. Asthma Education
    2. Asthma Management
    3. Emergency Management of Asthma Exacerbation
    4. Asthma Inpatient Management
    5. Status Asthmaticus
  2. Step 1: Inhaled Beta Agonist (e.g. Albuterol)
    1. Albuterol Trial
      1. Three treatments of Albuterol MDI 2-4 puffs each or
      2. One treatment of Albuterol Nebulizer
    2. Reassessment after 1 hour
  3. Step 2a: Good Response (Mild) with PEF>80%
    1. Signs
      1. No respiratory symptoms
      2. Sustained response to Albuterol for 4 hours
    2. Home Management
      1. Albuterol 2-4 puffs q3-4 hours for 24-48 hours
      2. Inhaled Corticosteroid if already using
        1. Double dose for 7-10 days
      3. Contact doctor in 48 hours for further management
  4. Step 2b: Incomplete Response (Moderate) with PEF 50-80%
    1. Signs
      1. Persistent Wheezing
      2. Shortness of Breath
      3. Cough
      4. Chest Tightness
    2. Home Management
      1. Albuterol 2-4 puffs q3-4 hours for 24-48 hours
      2. Oral Corticosteroid for 3 to 10 days
        1. Adult
          1. Prednisone 40-60 mg per day divided qd to bid or
          2. Depo-Medrol 160 mg IM for single dose
            1. Equal to Methylprednisolone 160 mg PO x8 days
            2. Effect may be delayed 48 hours
        2. Child: 1-2 mg/kg/day to maximum 60 mg/day
        3. No tapering needed if use less than 2 weeks
        4. Continue course until peak expiratory flow >70%
      3. Consider inhaled flunisolide
        1. As effective as oral Corticosteroids in children
        2. Nakanishi (2003) Chest 124:790
      4. Contact doctor urgently same day for recommendations
  5. Step 2c: Poor Response (Severe) with PEF <50%
    1. Signs
      1. Marked Wheezing
      2. Shortness of Breath, Cough or Chest Tightness
      3. Severe distress
      4. Inhaled Albuterol effect lasts less than 2 hours
    2. Immediate Management
      1. Albuterol inhaler 4-6 puffs every 20 minutes prn
      2. Start oral Corticosteroids
        1. Adult: 40 to 60 mg per day divided qd to bid
        2. Child: 1-2 mg/kg/day to maximum 60 mg/day
        3. No tapering needed if use less than 2 weeks
      3. Pursue immediate medical care
        1. Contact doctor
        2. Proceed to Emergency Department
        3. Call 911
  6. References
    1. (1997) Management of Asthma, NIH 97-4053
    2. (1995) Global Strategy for Asthma, NIH 95-3659
    3. Stoloff (1997) Am Fam Physician 56(1):117

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