Treatment of Acute or Sub-Acute Asthma Exacerbation: Shortness of Breath, Cough, Wheezing & Chest Tightness
This protocol addresses the management of an acute or sub-acute worsening of asthma — a significant deterioration in symptoms and lung function from the patient's usual condition.
Clinical Situation
An exacerbation is an acute or subacute worsening in symptoms and lung function compared with the patient's usual status. The presentation may include:
Shortness of breath
Cough
Wheezing
Chest tightness
In some patients, an exacerbation may be their initial presentation of asthma.
Treatment Approach
Management involves prompt inhaled short-acting bronchodilator therapy, along with controlled supplemental oxygen when indicated. For moderate exacerbations, systemic corticosteroids form an important part of the regimen — the full algorithm, approach by severity, and complete details are in the structured protocol.
Key Clinical Goals at 1 Hour
- Symptoms improved — reliever no longer needed
- Oxygen saturation >94% on room air
- Peak expiratory flow (PEF) improving toward target range
References
- An exacerbation is an acute or subacute worsening in symptoms and lung function, compared with the patient's usual status; some patients' initial presentation of asthma may be with an exacerbation.
- Start bronchodilator treatment with repeated doses of SABA (usually by pressurized metered-dose inhaler and spacer) and controlled flow oxygen, if needed and available.
- Inhaled albuterol (salbutamol) is the most common bronchodilator used to treat acute asthma.
- Start oral corticosteroids (except for mild exacerbations).
- Monitor closely: Check symptoms and oxygen saturation frequently. Measure lung function after 1 hour.
- Oxygen saturation >94% room air; PEF improving, and >60–80% of personal best or predicted.
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