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Adult Inpatient Asthma Exacerbation Algorithm

Adult Inpatient Asthma Exacerbation Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Respiratory, Related


Adult patient admitted to general care floor
Does patient
have any of the following?*
- FEV1 or PEF < 40% or unable to perform spirometry due to
work of breathing?
- Diffuse wheezes or poor air movement without wheezes?
- Breathless at rest/agitated or confused?
- In need of O
2
to keep SpO
2
> 92%?
Moderate or Severe Exacerbation
RT order and give albuterol 5 mg Q20
min x3 in 1
st
hour via nebulizer
RT order and give ipratropium
bromide 500 mcg Q20 min x3 via
nebulizer
Administer O
2
to maintain SpO
2
>92%
RT contact physician to consider non-
invasive ventilation and moving
patient to ICU/IMC
Mild Exacerbation
RT order and give albuterol 5 mg via
nebulizer x1.
RT order and give ipratropium
bromide 500 mcg via nebulizer x1 (if
using albuterol at home > q2-4 hours)
Administer O
2
to maintain SpO
2
>92%
No
RT assess response to intervention
(including spirometry)
Adult Inpatient Asthma Exacerbation Algorithm (Age 18 years or older)
Does patient
have any of the following?
- Subjective improvement of their shortness of breath?
- Decreased use of accessory muscles?
- Improved breath sounds?
RT order and give albuterol therapy 4-8 puffs via MDI with spacer or 2.5
mg via nebulizer. Frequency determined by triage score.* MDI is the
preferred delivery method. If the patient is unable to perform MDI
therapy adequately, give treatments via nebulizer. If the patient has an
artificial airway, refer to Bronchodilator via Artificial Airway Algorithm.
RT order and continue any long-acting beta agonist (LABA) or inhaled
corticosteroid (ICS) medications as patient receives at home, after
checking the pharmacy medication list. All other asthma medications
should be ordered per the admitting provider.
RT assess patient’s compliance and ability to self-administer all inhaled
medications. RT notify provider of patient compliance via progress note
and verbal communication.
RT initiate peak flow monitoring (CS# 3330773) twice daily 10 minutes
after bronchodilator therapy.
Yes
Refer to Bronchodilator
Follow-up Algorithm and
assess patient for self-
administration if indicated
RT contact physician to consider:
Moving patient to an ICU and starting
continuous bronchodilator therapy
Starting adjunct therapies such as
BiPAP, Heliox, or inhaled
corticosteroids
No
Was patient
admitted from
ED?
Yes
Yes
RT perform assessment (including spirometry)No
Reference: Asthma – Adult/Pediatric – Inpatient/Ambulatory/EmergencyDept Guideline
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org