1. Management of acute asthma The British Thoracic Society Scottish Intercollegiate Guidelines Network Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

2. Patients at risk of developing near fatal or fatal asthma Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 and Recognised by combination of: Severe asthma Adverse behavioural or psychosocial features

6. Levels of severity of acute asthma exacerbations Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Raised PaCO 2 and/or requiring mechanical ventilation with raised inflation pressures Near fatal asthma

11. Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features

12. Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features

13. Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Necessary to determine adequacy of oxygen therapy and need for arterial blood gas measurement. Aim of oxygen therapy is to maintain SpO 2  92% Pulse oximetry Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features

14. Initial assessment – the role of symptoms, signs and measurements Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Necessary for patients with SpO 2 <92% or other features of life threatening asthma Blood gases (ABG) Necessary to determine adequacy of oxygen therapy and need for arterial blood gas measurement. Aim of oxygen therapy is to maintain SpO 2  92% Pulse oximetry Measurements of airway calibre improve recognition of severity and guide hospital or at home management decisions. PEF is more convenient and cheaper than FEV 1 . PEF as % previous best value or % predicted most useful PEF or FEV 1 Clinical features, symptoms and respiratory and cardiovascular signs helpful in recognising severe asthma, but none specific, and their absence does not exclude a severe attack Clinical features

17. Management of acute severe asthma in adults in A&E: assessment of PEF Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92

18. Management of acute severe asthma in adults in A&E: PEF >75% predicted Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 60 min 15-30 min Clinically stable AND PEF >75% Give usual bronchodilator 5 min PEF >75% best or predicted: mild POTENTIAL DISCHARGE 120 min Measure PEF and arterial saturations Time

24. Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Management of acute severe asthma in adults in hospital: assessment of PEF

35. ß 2 -agonist bronchodilators for acute asthma in adults Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 In severe/poorly responsive asthma, consider continuous nebulisation A Use high dose inhaled  2 agonists first line in acute asthma given as early as possible, with IV  2 agonists if inhaled therapy cannot be used reliably A Use oxygen driven nebuliser in acute life threatening asthma 

36. Steroids and other therapy for acute asthma in adults Management of acute asthma. Thorax 2003; 58 (Suppl I): i1-i92 Routine prescription of antibiotics is not indicated for acute asthma B IV magnesium sulphate (1.2-2 g IV infusion over 20 minutes) and IV aminophylline should only be used following consultation with senior medical staff  Consider IV magnesium sulphate for patients with poorly responding acute severe or life threatening asthma A Nebulised ipratropium bromide (0.5mg 4-6 hourly) should be added to  2 agonist treatment if poor response to  2 agonist therapy A Give steroid tablets in adequate doses in all cases of acute asthma A Continue prednisolone 40-50mg daily for at least 5 days or until recovery 