First aid for acute asthma for patients and community members
First aid treatment in a community setting is often the initial intervention in acute asthma. All patients with asthma should have an individualised written asthma action plan that can be implemented at the first signs of an asthma exacerbation. For information about individualised asthma action plans; see Written asthma action plan for adults and Written asthma action plan for children.
The National Asthma Council ‘4×4×4’ first aid plan for treating acute asthma with salbutamol (via pressurised metered dose inhaler [pMDI]) is used by many community and sports organisations. It is simple to remember and easy to follow—the plan recommends:
salbutamol 100 micrograms per actuation, 4 actuations, 1 at a time via pMDI (with spacer if available, taking 4 breaths from the spacer after each actuation); repeat after 4 minutes if required. If still no response, call an ambulance, and continue giving 4 actuations (or up to 8 actuations in an adult) every 4 minutes. asthma, first aid salbutamol salbutamol salbutamol
If salbutamol is not immediately available, terbutaline or budesonide+formoterol can be used:
terbutaline (for people 6 years or older) 500 micrograms per actuation, 2 actuations, one at a time via DPI; give 1 more actuation after 4 minutes, if required. If still no response, call an ambulance and continue giving 1 actuation every 4 minutes asthma, first aid terbutaline terbutaline terbutaline
OR
budesonide+formoterol (for people 12 years or older), 2 actuations, one at a time via pMDI (with spacer if available) or DPI; give 1 more actuation after 4 minutes, if required. If still no response, call an ambulance and continue giving 1 actuation every 4 minutes1 up to a maximum total of 6 doses. asthma, first aid budesonide + formoterol budesonide+formoterol budesonide+formoterol
If the patient does not respond rapidly and significantly to initial treatment, an ambulance should be called (advising that the patient is having a ‘severe asthma attack’). If the patient initially responds to treatment but reliever therapy is needed more than 3 to 4 hourly, a same-day medical review is required. If symptoms are escalating, referral to an emergency department may be required.
See the National Asthma Council website for links to printable wallcharts of the first aid plans.