This protocol covers the patient experiencing an acute or sub-acute worsening of asthma — shortness of breath, cough, wheezing, or chest tightness — with deterioration in lung function compared with their usual status, whose response to first-line exacerbation management has been insufficient.
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 itself be with an exacerbation.
The preceding management step used inhaled short-acting beta2-agonist (salbutamol/albuterol) with controlled oxygen and, for moderate exacerbations, an oral corticosteroid.
That step aims for three outcomes assessed at one hour: symptoms improved with no further need for reliever medication; oxygen saturation greater than 94% on room air; and peak expiratory flow rising to more than 60–80% of personal best or predicted. When those targets are not met, this escalation protocol is the defined next step.
When a severe exacerbation is identified or the expected response has not been achieved, management involves immediate escalation to an acute care facility. The approach combines inhaled bronchodilator therapy with an anticholinergic agent, systemic anti-inflammatory treatment, and supplemental oxygen — with defined criteria for further escalation to intensive care. The complete regimen and all escalation criteria are contained in the full protocol.