Managing acute attacks of asthma [Educational Series: Asthma. Serialised guide. Management of asthma: the essentials of good clinical practice. Number 4 in the series]

Asthma patients may present to the health services with acute attacks. Assessment and management must be undertaken rapidly. The patient must be given oxygen and then assessed by measuring the peak expiratory flow rate (PEF) before and after salbutamol, and by questioning and examining the patient. Using the information gathered, the caregiver is able to assess the grade of severity of the attack and provide appropriate care according to the severity.

Patients judged as having imminent respiratory arrest must be immediately transferred to intensive care after starting treatment. Patients judged as having a severe attack are given oxygen, salbutamol, systemic corticosteroids and are closely monitored. They must remain for a minimum of 6 h prior to being either hospitalised or sent home. Patients with moderate attacks are given salbutamol and oral prednisone and are kept under observation for a minimum of 2 h. If stable at least 1 h after last dose of salbutamol, they may be sent home. Patients with mild attacks are given inhaled salbutamol and kept under observation for a minimum of 2 h. If stable at least 1 h after the last dose of salbutamol, they may be sent home. Careful and correct follow-up after an attack is crucial.