MANAGEMENT

● Management of acute exacerbation (at ED):

o Secure airway, breathing & circulation

o Continuous vital sign monitoring

● Treat according to severity:

Mild exacerbation Moderate exacerbation Severe exacerbation

● Neb Salbutamol + ● Neb Salbutamol + ● Neb salbutamol _

oral Prednisolone 1 oxygen 8L/min +/- ipratropium bromide +
mg/kg/day for 3-5 ipratropium bromide + oxygen 8L/min +
days oral prednisolone 1 continuous IV salbutamol

● Oxygen 8L/min mg/kg/day for 3-5 days 1-5 mcg/kg/min +/-

● Reassess after neb, MgSO4-

● Reassess after
admit if not improve ● IV hydrocortisone: 4x
nebulization; repeat if
bodyweight
not improving
● Admit to HDU/ ICU with
● If not improve, keep
continuous monitoring
& observe for 1 hour

Long-term management

● Asthma medication: stepwise approach based on asthma control

Intermittent Mild persistent Moderate Severe persistent Very severe

asthma asthma persistent asthma asthma persistent asthma

SABA PRN ● SABA PRN ● SABA PRN ● SABA PRN ● SABA PRN
● Low dose ● Moderate dose ● Moderate dose ● Moderate dose
ICS (100- ICS (200-400 ICS (400-800 ICS comb therapy
200 mcg) mcg) mcg) comb + montelukast or
therapy, or high dose ICS
high dose ICS (800- 1200 mcg)
 comb therapy
● Continuous asthma education to parents

o Recognize trigger

o S&S for asthma attack

o Medications dosage, technique & side effects

● Prevention:

o Avoidance of triggers

o Adherence to preventive medication

o Rest as much as possible

o Avoid doing activities like running, jumping, playing with flowers etc

o Wear thick clothes during cold weather

● Discharge & predischarge counselling

o Teach about correct inhaler technique

o Asthma action plan- educate parents to adjust medication based on severity/

S&S

● Follow up assessment in clinic

o Asses the side effects of medications

o Review inhaler technique
o Give personalized asthma management advice
o Advice and review on dietary intake (especially if the patient allergic to the
food)
o Assessment of asthma control and adjustment of medication degree

● Self-management

o Understanding asthma and breathing technique

o Making changes in life to prevent asthma problems
o Following good health habits like quitting smoking, managing stress and
exercising to stay active