Asthma: Mild/Moderate/Severe (Adult)
 
Status
Respiratory distress
   
Assess
• Severity of distress
• If Pt’s asthma Mx plan has been activated
         
Mild or Moderate
Salbutamol pMDI and spacer
- Deliver 4 puffs, 4 minutely until resolution of symptoms
If pMDI spacer unavailable
- Salbutamol 10mg (5ml) Nebulised
- Repeat Salbutamol 5mg (2.5ml) Nebulised, 5 minutely if required
         
Adequate Response   No Signifcant Response after 10 minutes
Transport with continued
reassessment		   Mx as per Severe
 
Severe
Salbutamol 10mg (5ml) and Ipratropium Bromide 500mcg (2ml) Nebulised
- Repeat Salbutamol 5mg (2.5ml) Nebulised, 5 minutley if required
Salbutamol 250mcg IV
- Repeat Salbutamol 125mcg IV, 5 minutely if required (max 500mcg)
Dexamethasone 8mg IV
If unimproved:
Salbutamol infusion IV, at 15mcg/minute (45ml/hr)
 
Special Notes
Asthmatic Pts are dynamic and can show initial improvement with treatment then deteriorate rapidly.
Consider MICA support but do not delay transport waiting for backup.
Despite hypoxaemia being a late sign of deterioration, pulse oximetry should be used throughout Pt contact (if available).
An improvement in SpO2 may not be a sign of improvement in clinical condition.
Beware of Pt presenting wheeze associated with heart failure and no asthma / COPD Hx.
pMDI = Pressurised Metered Dose Inhaler
 
General Care
Salbutamol infusion (MICA)
- 1mg Salbutamol added to Dextrose 5% or Normal Saline to make 50ml.
- 15mcg/min = 45ml/hr