II. Risk Factors: Fatal Asthma attack
III. Classification: Asthma Exacerbation Severity
- See Asthma Exacerbation Severity Evaluation
- Mild Asthma Exacerbation
- Dyspnea on exertion (or Tachypnea in young children)
- Peak Expiratory Flow (PEF) >70% of predicted
- Prompt relief with inhaled Short-acting Beta Agonists
- Home management
- Moderate Asthma Exacerbation
- Dyspnea limits usual activity
- Peak Expiratory Flow (PEF) 40-69% of predicted
- Relief with frequent inhaled Short-acting Beta Agonists
- Office management
- Add oral Systemic Corticosteroids
- Anticipate 1-2 days of symptoms after treatment onset
- Severe Asthma Exacerbation
- Dyspnea at rest, limiting conversation
- Peak Expiratory Flow (PEF) <40% of predicted
- Only partial relief with inhaled Short-acting Beta Agonists
- Emergency department management
- Hospitalization is likely
- Add Systemic Corticosteroids and ipratroprium
- Anticipte >3 days of some symptoms
- Life Threatening Asthma Exacerbation
- Unable to speak, severe Dyspnea with associated diaphoresis
- Peak Expiratory Flow (PEF) <25% of predicted
- Minimal relief with inhaled Short-acting Beta Agonists
- Emergency department stabilization
- Intensive Care unit admission
- Frequent or continuous Albuterol nebs
- Add Systemic Corticosteroids and ipratroprium
- ABC Management
IV. Management
- See Asthma Exacerbation Home Management
- See Emergency Management of Asthma Exacerbation
- Asthma presenting to clinic with Oxygen Saturation at or below 90% may be best managed in emergency department
- See Asthma Inpatient Management
- See Status Asthmaticus
V. References
- (2007) Guidelines for the diagnosis and management of Asthma, NHLBI