ACUTE EXACERBATION OF
ASTHMA
MUHAMMAD FAEZ MOMIN
ED SPECIALIST NURSE KPJBMSH
8/4/2025
DEFINITION
• Asthma is an inflammatory disease of the airways triggered by
external stimuli in genetically-predisposed individuals. This leads to
mucus secretion, bronchoconstriction and airway narrowing.
• Acute exacerbation of asthma is defined as progressive or sudden
onset of worsening symptoms such as shortness of breath, chest
tightness, wheezing and coughing. Early recognition is required to
prevent morbidity and mortality as symptoms can progress rapidly to
respiratory failure and death.
LEVEL OF SEVERITY OF ACUTE EXACERBATION OF ASTHMA
MANAGEMENT
1. Obtain history and perform physical examination:
A - Airway:
• Ensure a clear and patent airway, addressing any obstruction or swelling that
could impair breathing.
B - Breathing:
• Assess the patient's respiratory effort, rate, and oxygen saturation. Administer
supplemental oxygen as needed and consider bronchodilators to improve
airflow.
C - Circulation:
• Evaluate the patient's heart rate, blood pressure, and perfusion. Monitor for signs
of circulatory compromise and address any underlying issues.
D - Disability:
• Assess the patient's level of consciousness and neurological status. Look for
signs of confusion, agitation, or lethargy, which could indicate hypoxia or other
complications.
E - Exposure:
• Identify any potential triggers or contributing factors to the asthma exacerbation,
such as allergens, infections, or medications.
MANAGEMENT
2. Obtain peak expiratory flow rate (PEFR)
3. Obtain ABG and CXR
4. Give oxygen 2-5L/min via nasal prong. High concentration of oxygen
(>40%) in cases with initial PEFR <50% at presentation
5. Give high dosed of inhaled beta2 agonist (salbutamol 5mg) via nebulizer
driven oxygen
6. Consider adding anticholinergic (e.g: Ipratropium Bromide 0.5mg) to
nebulised beta2 agonist or combined beta2 agonist and anticholinergic (e.g:
neb combivent) for patients with acute severe asthma
MANAGEMENT
7. Give IV hydrocortisone 200mg stat, then 100mg-200mg QID.
Nebulized steroid (e.g: Pulmicort 1mg TDS/ BD) could be given
8. Give nebulised Combivent 4-6 hourly if patient is not improving
MANAGEMENT
If very severe/life threatening asthma:
9. Give IV Salbutamol 250microgram over 10mins. Repeat dose if necessary
10. Give IV aminophylline 250mg slowly over 20mins
11. Can consider IV MgSO4 2g in 20cc NS over 20 minutes
12. If patient not improve, to give Aminophylline infusion (0.5-0.9mg/kg/H)
13. Consider intubation
14. Antibiotics are indicated if there is evidence of a bacterial infection
**patient with features of life threatening asthma require admission to ICU
NURSING PROBLEM PRIORITIES
1. Improving Breathing Pattern & Gas Exchange
2. Maintaining Patent Airways & Reducing Airway Inflammation
3. Medical Administration and Pharmacologic Support
4. Reducing Anxiety & Improving Coping
5. Promoting Rest & Energy Conservation
6. Providing Patient Education & Health Teachings
Health education before discharge
• Review adequacy of usual treatment and step up if necessary
according to guidelines for treatment of chronic persistent asthma
• Ensure pt has enough supply of medications
• Check inhaler technique and correct if faulty
• Advice pt to seek medical advice immediately if condition worsens
• Make sure pt has a clinic follow up appointment
THANK YOU FOR YOUR LISTENING…