Below are the latest Australian guidelines from the Australian Asthma Handbook published by National Asthma Council Australia (2019) for acute and life-threatening asthma management. For management of the seriously unwell asthmatic go to the ECI asthma tool on the crashing asthmatic.
Asthma management guidelines have also been published in the UK (2016) and the USA (2007), however there is no consensus on the use of IV salbutamol or IV aminophylline. Although advocated by all three parties, there is no consistent administration regime for magnesium sulphate.
Summary of treatment steps (NAC guidelines):
Inhaled bronchodilators = mainstay of treatment
Add ipratropium if poor response to salbutamol alone
If poor response to 2 bronchodilators consider other ‘Add-on’ therapies (IV magnesium, IV salbutamol)
Steroids for ALL patients within first hour (unless 0-5 years old and wheezing responds to initial bronchodilator therapy)
Trial of NIV if deteriorating
Breakfast at Glenfield - The educational music video about ACUTE ASTHMA, Glenfield Hospital, 2013
This video was made by the clinical team at Glenfield Hospital, Leicester, UK to promote awareness of asthma guidelines at their hospital and to improve the management of acute asthma. It is the winner of the British Thoracic Society Innovation in Education Award 2012 and the NHS Expo / Network Casebook II Innovation Award 2013. It was filmed during the clinicians spare time with no budget.