ACUTE ASTHMA TREATMENT

In the following order (escalating the therapy if inadequate response after 1 hour or earlier if progressive deterioration)

  • Salbutamol neb*  - 1ml (+ 3ml Saline) neb (1-3 consecutively)

OR

  • Salbutamol  & Ipratropium bromide neb* - 1ml:1ml (+2ml Saline neb) x (1-3 onsecutively)

AND

  • Predisolone (1mg/kg) 50mg stat PO

 

  • Salbutamol neb neat - 4ml neb (continuous nebs)
  • Hydrocortisone 2-4 mg/kg (max 200mg)  IV stat (then 6/24 hrly) OR
    Dexamethasone 0.6mg/kg  (max 8mg) IV OR
    Methylprednisolone 1-2mg/kg (max 120mg) IV
  • Salbutamol 250mcg IV (over 5 min) then Salbutamol IV infusion 10mcg/min
  • MgSO4 10 mmol/100ml NSaline (over 15 min)

 

  • Adrenaline neb 6mg/6ml x 3

 

  • Aminophylline 5mg/kg IV (over 30min) then Aminophylline IV (0.5mg/kg/hr)

 

  • Adrenaline 0.5mg (over 5-10min) then Adrenaline 10mcg/min

All severe asthmatics require continuous monitoring for both
the effects of the disease and the side effects of treatment (see below)

*Salbutamol neb (5mg/ml)

*Ipratropium Bromide (500mcg/ml)

ASTHMA DRUGS AND SIDE EFFECTS

DRUG ADVERSE DRUG REACTIONS
Oxygen Hypercarbia (in CO2 retainers)
Salbutamol Tachycardia
Tremor
Hypokalaemia
Lactic acidosis
Ipratropium bromide Acute angle-closure glaucoma
Dry mouth
Cough
Adrenaline Tachyarrhythmias
Hypertensive crisis
Hypokalaemia
MgSO4 Hypotension
Aminophylline Arrhythmias