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SEVERE ASTHMA

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Normal Values Pulse and Respiratory Rate

AGE(years) Pulse(per minute) Respiratory Rate(per minute)
<2 100-160 25-40
2-5 95-140 25-30
5-12 80-120 20-25
>12 60-100 15-20

CLASSIFICATION

Mild/moderate Severe Life threatening
  • Absence of life threatening features of consciousness
  • Sa02 > 93% in air
  • Too breathless.
  • Respiratory rate >40/min (>50/min <5yrs)
  • Pulse >120/min (>140/min < 5yrs)
  • PEFR < 50% predicted
  • PEFR <33%  predicted.
  • Cyanosis, silent chest.
  • Fatigue or exhaustion.
  • Decreased consciousness

Chest x-ray in

  • Asymmetrical signs
  • Severe attack
  • Intubated
  • Differential diagnosis

TREATMENT:

Mild / moderate episodes

High flow oxygen

  • Salbutamol
  • 4 – 10 puffs via spacer
  • Repeat every 20 – 30 min

Oral prednisolone

  •  20 mg < 5 yrs
  • 30 – 40mg > 5yrs
  • In vomiting, hydrocortisone 4mg /kg /dose 6 hourly
  • If poor response add

Ipratropium bromide (20 micrograms/puff)

  • 2 – 4 puffs via spacer
  • Repeat up to every 20-30 min( in first hour)

REASSESS WITHIN ONE HOUR

Severe Asthma

 · High flow oxygen
· Nebulised Salbutamol and Ipratropium
· Oral prednisolone 
IV drugs:
· IV hydrocortisone if vomiting
· IV aminophylline over 30 mins (5mg/kg loading)
· IV salbutamol– Bolus or infusion(ECG monitoring and electrolytes)
· IV Magnesium sulphate (single dose 40mg/kg/day (max 2g) slow infusion)

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