(BQ) Part 2 book “ABC of asthma” has contents: Treatment of acute asthma, methods of delivering drugs, definition, prevalence and prevention, patterns of illness and diagnosis, pharmacological therapies for asthma, acute severe asthma, clinical aspects of managing asthma in primary care, and other contents. | CHAPTER 9 Treatment of Acute Asthma John Rees Sherman Education Centre, Guy’s Hospital, London, UK OVERVIEW • Most problems in acute severe asthma result from under-treatment and failure to appreciate severity • Forty to sixty percent oxygen should be given with a reservoir mask to achieve oxygen saturations above 94% • A spacer device can deliver bronchodilators as effectively as a nebuliser in most cases of acute asthma • Corticosteroids should be used early in acute attacks of asthma • Discharge too early after an acute attack is associated with increased readmission and mortality Introduction The initial assessment of a patient with increased symptoms of asthma is very important. Most problems result from undertreatment and failure to appreciate severity. Monitor the peak flow rate and other signs before and after the first nebuliser treatment and then as appropriate (Figure ). In hospital, peak flow should be monitored at least four times daily for the duration of the stay. A flow chart for the management of asthma at home is shown in Chapter 8 and a flow chart for management in hospital is shown later in this chapter. The various aspects of treatment are considered individually in this chapter. or 28% oxygen by Venturi mask until the results of blood gas measurements are available. Details of oxygen delivery and target saturation should be written clearly on the prescription sheet. Nasal cannulae, simple facemasks or reservoir masks should be prescribed to obtain a target saturation of 94–98% β-agonists Adrenaline has been used in the treatment of asthma since just after the First World War. The specific short-acting β2 -agonists such as salbutamol and terbutaline have replaced the earlier non-selective preparations for acute use. There are no great differences in practice between the commonly used agents. If long-acting bronchodilators are used they can be continued during the attack. Use and availability of nebulisers In acute asthma, metered .
