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Management of Asthma Exacerbation in Primary Care Algorithm

Management of Asthma Exacerbation in Primary Care Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Respiratory, Related


Patient presentation with acute or
sub-acute asthma exacerbation
Management of Asthma Exacerbation in Primary Care (Age 2 years or older)
Assess the Patient
-Is it asthma?
- What is the exacerbation severity?
- Does the patient exhibit risk factors
for asthma-related death?*
Mild or Moderate
Exacerbation
Severe
Exacerbation
TRANSFER TO ED
While waiting, give dual therapy
(SABA + ipratropium bromide),
administer O
2
, and/or oral
corticosteroid (OCS)
*Risk Factors for Asthma-
related Death
History of near-fatal
asthma requiring
intubation and
mechanical ventilation
Hospitalization or
emergency care visit
for asthma in the past
year
Currently using or
recently stopped using
oral corticosteroids
Not currently using
inhaled corticosteroids
Over-use of SABAs,
especially use of more
than one canister of
monthly
A history of psychiatric
disease or psychosocial
problems
Poor adherence with
asthma medications
and/or poor adherence
with (or lack of) a
written asthma action
plan
Food allergy in a
patient with asthma
Initiate Treatment
- Short-acting beta
2
-agonist (SABA) by
pMDI with spacer or nebulizer
- Administer O
2
to maintain SpO
2
>90%
Continue Treatment
- Administer Short-acting beta
2
-agonist
(SABA) as needed
- If no resolution after initial treatment, give
dual therapy (SABA + ipratropium bromide)
-Consider oral corticosteroid (OCS)
Assess Response
- Have symptoms improved (not needing SABA)?
-Is O
2
saturation (on room air) > 90%?
- Are resources at home adequate?
Symptoms
Resolved?
Reference: Asthma –Adult/Pediatric – Inpatient/Ambulatory/EmergencyDept Guideline
Yes
Follow-up within 2-7 days to assess stabilization
- Rescue Medication: reduce to as-needed
- Controller Medication: continue higher dose for short term (1-2 weeks) or long
term (3 months), depending on background to exacerbation
-Continue oral corticosteroid (OCS) as needed (5-7 days in adults; 3-5 days in pediatrics)
- Risk factors for exacerbation: provide patient education, including inhaler technique/adherence
- Print and review Asthma Action Plan (Note: If pediatric patient, print 2 copies for home/school)
No
Symptoms
Resolved?
Yes
No
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org