Overview

To determine the severity of severe acute asthma, see Assessing severity of acute asthma. Summary of management of acute asthma provides a summary of management of acute asthma according to severity.

For a patient with severe acute asthma according to the initial rapid assessment, start treatment with both salbutamol and ipratropium.

If oxygen saturation measured by pulse oximetry (SpO₂) is less than 92%, also start supplemental oxygen therapy. Titrate oxygen to a target SpO₂ of 92 to 96%. For more detailed advice on supplemental oxygen administration, see Acute oxygen therapy.

Immediately after starting treatment, perform a more detailed secondary severity assessment to determine ongoing treatment.

All patients should also receive oral corticosteroid (or intravenous, if oral intake is not possible) therapy as soon as practical (and at least within the first hour of presentation). See Corticosteroid therapy for acute asthma for indications and doses.

If symptoms improve or resolve, bronchodilator treatment can be used less frequently or stopped. Monitor the patient for at least an hour after symptom resolution in case symptoms recur.

If the patient worsens or does not have a rapid and marked response to treatment, consider escalating treatment to that used for life-threatening acute asthma. Intravenous magnesium sulfate may be required. If the patient is being managed in primary care, arrange transfer to a hospital.