Overview

To determine the severity of life-threatening 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.

Consider anaphylaxis as a differential diagnosis—see Anaphylaxis and acute asthma for more information.

For a patient with life-threatening acute asthma according to the initial rapid assessment, arrange immediate transfer to a critical care or high-dependency facility. Early involvement of senior staff is desirable for very sick patients.

Start immediate treatment with nebulised bronchodilator therapy (both salbutamol and ipratropium). Supplemental oxygen therapy is almost always required in these patients—use to drive the nebuliser.

Give intravenous corticosteroid therapy as soon as possible (and at least within the first hour). See Corticosteroid therapy for acute asthma for indications and doses.

Immediately after starting treatment, perform a more detailed secondary severity assessment. Depending on the response to initial treatment, intravenous magnesium sulfate may be required. Additional therapy or ventilatory support may be required in difficult cases.

Continuously reassess severity and response to treatment to determine ongoing management.

If the patient is unresponsive, has poor respiratory effort, and cannot inhale bronchodilators, or is considered to be peri-arrest, consider adrenaline (epinephrine).