Asthma Exacerbation Home Management

Aka: Asthma Exacerbation Home Management

1. See Also
   1. Asthma Exacerbation
   2. Asthma Education
   3. Asthma Management
   4. Emergency Management of Asthma Exacerbation
   5. Asthma Inpatient Management
   6. Status Asthmaticus
2. Contraindications: Patients who require immediate medical attention (home management protocol no recommended)
   1. High risk of fatal Asthma attack
      1. See Asthma Exacerbation for risks of Asthma-related death
   2. Serious exacerbation signs and symptoms
      1. Significant breathlessness
      2. Unable to speak in short phrases
      3. Accessory muscle use
      4. Lethargy
      5. Peak expiratory flow <50%
3. Management: Step 1 - Inhaled Beta Agonist (e.g. Albuterol)
   1. Albuterol Trial
      1. Up to 2 treatments of Albuterol MDI 2-6 puffs each (with 20 minutes interval between each use) OR
      2. One treatment of Albuterol Nebulizer
   2. Reassessment after 1 hour
4. Management: Step 2a - Good Response (Mild) with PEF>80%
   1. Signs
      1. No Wheezing, Dyspnea or Tachypnea
      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
         2. Increased dosing has variable efficacy for acute exacerbation
      3. Consider oral Corticosteroids
      4. Contact medical provider in 48 hours for further management
5. Management: Step 2b - Incomplete Response (Moderate) with PEF 50-79%
   1. Signs
      1. Persistent Wheezing
      2. Shortness of Breath
      3. Tachypnea
      4. Cough
      5. 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. Contact medical provider urgently same day for recommendations
6. Management: 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
7. References
   1. Pollart (2011) Am Fam Physician 84(1): 40-7
   2. (1997) Management of Asthma, NIH 97-4053
   3. (1995) Global Strategy for Asthma, NIH 95-3659
   4. Stoloff (1997) Am Fam Physician 56(1):117-26