Acute asthma exacerbation in adults

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

life-threatening exacerbation or impending respiratory failure

Plus – admission to intensive care unit

Back

Plus –

admission to intensive care unit

Treatment recommended for ALL patients in selected patient group

For details of how to classify the patient, see Diagnosis recommendations.

Admit to an intensive care or high-dependency unit those patients requiring ventilatory support and those with acute severe or life-threatening asthma who fail to respond to standard therapy. To assess this, look for:[1][13]

Deteriorating peak expiratory flow (PEF)
Persistent or worsening hypoxia
Hypercapnia
Arterial blood gas analysis showing a fall in pH or rising hydrogen concentration
Exhaustion
Feeble respiration
Drowsiness, confusion, or altered consciousness
Respiratory arrest.

Admit the patient and obtain help from a senior/intensive care colleague immediately.[13]

The patient should be accompanied by a nurse or doctor at all times.[13]

Perform a primary survey, assessing the patient’s airway, breathing, and circulation.[1]

For patients in cardiorespiratory arrest, start CPR according to your regional adult advanced life support guidelines and call for help. In the UK, consult the UK Resuscitation Council guidelines.[59]

Closely monitor all patients when giving treatment in any setting and titrate treatment according to response.[1] People with asthma who have respiratory symptoms are at risk of becoming seriously unwell very quickly.[13]

In the community

In the community, arrange immediate hospital admission via an ambulance for any patient with possible life-threatening asthma and for patients with acute severe asthma (including pregnant patients).[13] See Diagnosis recommendations.

Alert the receiving hospital unit.

Consider other factors, such as failure to respond to treatment, comorbidities, or social circumstances, when considering which patients to refer.[13]

Appropriate treatment should be started (where available) while transfer to hospital is arranged.[1] Stay with the patient until the ambulance arrives.[13]

The patient may receive a short-acting beta-2 agonist via oxygen-driven nebuliser in the ambulance.[13]

Most asthma deaths occur before admission to hospital.[13]

Consider – oxygen

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Consider –

oxygen

Additional treatment recommended for SOME patients in selected patient group

Urgently give supplementary oxygen to hypoxaemic patients, using a face mask, Venturi mask, or nasal cannula with flow rates adjusted as necessary to maintain an oxygen saturation (SpO₂) of 93% to 95%.[1]

Controlled, low-flow oxygen is associated with better outcomes than high concentration of oxygen.[1][51]

Monitor SpO₂. Record oxygen saturation by pulse oximetry. Maintain arterial SpO₂ at 93% to 95%.[1]

Do not delay oxygen administration in the absence of pulse oximetry.[13]

Repeat arterial blood gas within one hour of starting treatment if:[13]

initial partial pressure of oxygen (PaO₂) is <8 kPa (<60 mmHg) unless SpO₂ is >92%, or
initial partial pressure of carbon dioxide (PaCO₂) is normal or raised, or
the patient’s condition deteriorates.

Repeat blood gas measurements and pulse oximetry again at 4 to 6 hours if the patient’s condition has not improved.[13]

Monitor the patient for hypercapnia. Hypercapnia indicates the development of near-fatal asthma.[13] Call for emergency specialist/anaesthetic intervention if hypercapnia is present. Take care to avoid hypoxia as well as over-oxygenation.[13]

Continue to give oxygen if the patient is not improving after 15 to 30 minutes of treatment.[13]

Plus – short-acting bronchodilator

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Plus –

short-acting bronchodilator

Treatment recommended for ALL patients in selected patient group

Give a high-dose inhaled short-acting beta-2 agonist (e.g., salbutamol) as a first-line agent as early as possible.[13]

Inhaled beta-2 agonists act quickly and have few side-effects.[13]
Inhaled beta-2 agonists are as efficacious and are preferable to intravenous beta-2 agonists.[13]

Administer by wet nebulisation driven by oxygen.[13]

Use a flow rate of at least 6 L/minute[13]
Fit a high-flow regulator where oxygen cylinders are used.[13]
There is a risk of oxygen desaturation if using an air-driven compressor.[13]
Still administer nebulised therapy, even in the absence of supplemental oxygen.[13]

Measure and record PEF before and after the short-acting beta-2 agonist is given, and at least 4 times daily throughout the patient’s hospital stay.[13]

Use a metered-dose inhaler with a spacer for the beta-2 agonist if a nebuliser is not available. This recommendation is based on clinical experience because there is insufficient evidence for guidelines to recommend the use of a metered-dose inhaler with a spacer for life-threatening or acute severe asthma.[1][13]

Give intravenous beta-2 agonists to the patient in whom inhaled therapy cannot be used reliably.[13]

Consider monitoring serum lactate when using intravenous beta-2 agonists.[13]

In ventilated patients, consider parenteral beta-2 agonists in addition to inhaled beta-2 agonists. There is limited evidence to support this.[13]

If the patient is not improving after 15 to 30 minutes of treatment, use continuous (i.e., ‘back to back’) nebulisation of salbutamol. Alternatively, give repeat doses at 15 to 30 minute intervals.[13]

Add nebulised ipratropium to short-acting beta-2 agonist treatment, via an oxygen-driven nebuliser.[13]

Combined therapy produces significantly greater bronchodilation than a short-acting beta-2 agonist alone, leading to a faster recovery and shorter duration of admission.[13]
Continue ipratropium every 4 to 6 hours until the patient improves.[13]

Primary options

salbutamol inhaled: 5 mg inhaled via nebuliser every 20-30 minutes or when required; (100 micrograms/dose inhaler) 2-10 puffs inhaled every 10-20 minutes or when required (each puff should be inhaled separately via a large volume spacer)

and

ipratropium inhaled: 500 micrograms inhaled via nebuliser every 4-6 hours when required

Secondary options

salbutamol: consult specialist for guidance on intravenous dose

Plus – systemic corticosteroid

Back

Plus –

systemic corticosteroid

Treatment recommended for ALL patients in selected patient group

Give a corticosteroid as early as possible.[13] The European Respiratory Society/European Academy of Allergy and Clinical Immunology (ERS/EAACI) and the Global Initiative for Asthma (GINA) recommend doing this within 1 hour.[1][51]

Give oral prednisolone, provided it can be swallowed and retained by the patient.[13]
Consider parenteral hydrocortisone or methylprednisolone as an alternative to oral treatment, where oral treatment is not possible (e.g., the patient is too dyspneic to swallow, is vomiting, or requires non-invasive ventilation or intubation).[1][13]

Continue prednisolone (or the alternative parenteral corticosteroid) until recovery (for a minimum of 5 days).[13]

Switch the parenteral corticosteroid to an oral corticosteroid when an oral treatment can be tolerated by the patient.

Do not stop inhaled corticosteroids during prescription of oral or parenteral corticosteroids.[13]

Primary options

prednisolone: 40-50 mg orally once daily for at least 5 days

Secondary options

hydrocortisone sodium succinate: 100 mg intravenously every 6 hours; convert to oral prednisolone as soon as possible to complete course

methylprednisolone sodium succinate: 160 mg intramuscularly (depot formulation) as a single dose

Plus – supportive care

Consider – magnesium sulfate

Back

Consider –

magnesium sulfate

Additional treatment recommended for SOME patients in selected patient group

Consider a single dose of intravenous magnesium sulfate for the patient with asthma with PEF <50% of best or predicted who has not responded well to initial inhaled bronchodilator therapy.[1][13]

Intravenous magnesium sulfate has been shown to reduce hospital admissions in severe exacerbations and in those who fail to respond to initial treatment.[51]
Consult senior colleagues before use.

Nebulised magnesium sulfate is not recommended for treatment in adults with acute asthma.[13]

Primary options

magnesium sulfate: 1.2 to 2 g by intravenous infusion over 20 minutes

Consider – aminophylline

Back

Consider –

aminophylline

Additional treatment recommended for SOME patients in selected patient group

Consult senior colleagues before using intravenous aminophylline.[13]

It is not likely to offer additional benefit and has known side effects.[13]
Consider in patients with life-threatening asthma who have had a poor response to initial therapy.
Check blood theophylline levels on admission in any patient already taking oral aminophylline or theophylline.[13]
Check blood levels daily for all patients on aminophylline infusions until intravenous aminophylline is discontinued.[13]

Measure the serum theophylline concentration if aminophylline is continued for more than 24 hours (aim for a concentration of 10–20 mg/L [55-110 micromol/L], although lower concentrations may be effective).[13] Adverse effects can occur at this range; however, the frequency and severity increase at concentrations >20 mg/L. Adjust the infusion rate as necessary.

Primary options

aminophylline: 250-500 mg (maximum 5 mg/kg) intravenously as a loading dose, followed by 500-700 micrograms/kg/hour intravenous infusion, adjust dose according to plasma theophylline concentration

Consider – mechanical ventilation

Consider – antibiotic therapy

acute severe exacerbation

1st line – short-acting bronchodilator

Back

1st line –

short-acting bronchodilator

Give a high-dose inhaled short-acting beta-2 agonist (e.g., salbutamol) as a first-line agent as early as possible.[13]

Inhaled beta-2 agonists act quickly and have few side-effects.[13]
Inhaled beta-2 agonists are as efficacious and are preferable to intravenous beta-2 agonists.[13]

Administer by wet nebulisation driven by oxygen.[13]

Use a flow rate of at least 6 L/minute[13]
Fit a high-flow regulator where oxygen cylinders are used.[13]
There is a risk of oxygen desaturation if using an air-driven compressor.[13]
Still administer nebulised therapy, even in the absence of supplemental oxygen.[13]

Measure and record peak expiratory flow (PEF) before and after the short-acting beta-2 agonist is given, and at least 4 times daily throughout the patient’s hospital stay.[13]

Use a metered-dose inhaler with a spacer for the short-acting beta-2 agonist if a nebuliser is not available. This recommendation is based on clinical experience because there is insufficient evidence for guidelines to recommend the use of a metered-dose inhaler with a spacer for life-threatening or acute severe asthma.[1][13]

Give intravenous beta-2 agonists to the patient in whom inhaled therapy cannot be used reliably.[13]

Consider monitoring serum lactate when using intravenous beta-2 agonists.[13]

If the patient is not improving after 15 to 30 minutes of treatment, use continuous (i.e., ‘back to back’) nebulisation of salbutamol if there is an inadequate response to initial treatment. Alternatively, give repeat doses at 15 to 30 minute intervals.[13]

Add nebulised ipratropium to short-acting beta-2 agonist treatment, via an oxygen-driven nebuliser.[13]

Combined therapy produces significantly greater bronchodilation than a short-acting beta-2 agonist alone, leading to a faster recovery and shorter duration of admission.[13]
Continue ipratropium every 4 to 6 hours until the patient improves.[13]

In the community

Admit any patient with acute severe asthma to hospital via an ambulance.[13]

Appropriate treatment should be started (where available) while transfer to hospital is arranged.[1] Stay with the patient until the ambulance arrives.[13]
Send written assessment and referral details to the hospital.
The patient may receive a short-acting beta-2 agonist via oxygen-driven nebuliser in the ambulance.[13]

Pregnancy

Treat all pregnant women with acute severe asthma in hospital.[13]

Call for senior obstetric support. Quickly refer to critical care pregnant women with acute severe asthma.[13]

Acute severe asthma in pregnancy is an emergency and should be treated vigorously.[13]

Treat with drug therapy as for non-pregnant patients including systemic corticosteroids and magnesium sulfate.[34]

Immediately deliver high-flow oxygen to maintain a saturation of 93% to 95%.[1]

Progesterone-driven increase in minute ventilation may lead to relative hypocapnia and respiratory alkalosis and higher PaO₂, but oxygen saturations are unaltered.[13]
Acidosis is poorly tolerated by the fetus.[13]

Use continuous fetal monitoring.[13]

Primary options

and

ipratropium inhaled: 500 micrograms inhaled via nebuliser every 4-6 hours when required

Secondary options

salbutamol: consult specialist for guidance on intravenous dose

Consider – oxygen

Back

Consider –

oxygen

Additional treatment recommended for SOME patients in selected patient group

Controlled, low-flow oxygen is associated with better outcomes than high concentration of oxygen.[1][51]

Monitor SpO₂. Record oxygen saturation by pulse oximetry. Maintain arterial SpO₂ at 93% to 95%.[1]

Repeat arterial blood gas within one hour of starting treatment if:[13]

initial partial pressure of oxygen (PaO₂) is <8 kPa (<60 mmHg) unless SpO₂ is >92%, or
initial partial pressure of carbon dioxide (PaCO₂) is normal or raised, or
the patient’s condition deteriorates.

Repeat blood gas measurements and pulse oximetry again at 4 to 6 hours if the patient’s condition has not improved.[13]

Do not delay oxygen administration in the absence of pulse oximetry.[13]

Continue to give oxygen if the patient is not improving after 15 to 30 minutes of treatment.[13]

Plus – systemic corticosteroid

Back

Plus –

systemic corticosteroid

Treatment recommended for ALL patients in selected patient group

Give a corticosteroid as early as possible.[13] The European Respiratory Society/European Academy of Allergy and Clinical Immunology (ERS/EAACI) and GINA recommend doing this within 1 hour.[1][51]

Give oral prednisolone, provided it can be swallowed and retained by the patient.[13]
Consider parenteral hydrocortisone or methylprednisolone as an alternative to oral treatment, where oral treatment is not possible (e.g., the patient is too dyspneic to swallow, is vomiting, or requires non-invasive ventilation or intubation).[1][13]

Continue prednisolone (or the alternative parenteral corticosteroid) until recovery (for a minimum of 5 days).[13] Switch the parenteral corticosteroid to an oral corticosteroid when an oral treatment can be tolerated by the patient.

Do not stop inhaled corticosteroids during prescription of oral or parenteral corticosteroids.[13]

Primary options

prednisolone: 40-50 mg orally once daily for at least 5 days

Secondary options

hydrocortisone sodium succinate: 100 mg intravenously every 6 hours; convert to oral prednisolone as soon as possible to complete course

methylprednisolone sodium succinate: 160 mg intramuscularly (depot formulation) as a single dose

Plus – supportive care

Plus – monitoring

Consider – magnesium sulfate

Back

Consider –

magnesium sulfate

Additional treatment recommended for SOME patients in selected patient group

Consider a single dose of intravenous magnesium sulfate for patients with acute severe asthma (PEF <50% of best or predicted) who have not responded well to initial inhaled bronchodilator therapy.[1][13]

Intravenous magnesium sulfate has been shown to reduce hospital admissions in severe exacerbations and in patients who fail to respond to initial treatment.[51]
Consult senior colleagues before use.

Nebulised magnesium sulfate is not recommended for treatment in adults with acute asthma.[13]

Primary options

magnesium sulfate: 1.2 to 2 g by intravenous infusion over 20 minutes

Consider – antibiotic therapy

moderate exacerbation

1st line – short-acting bronchodilator

Back

1st line –

short-acting bronchodilator

Immediately administer a short-acting beta-2 agonist (e.g., salbutamol) by repeated activations of a pressurised metered-dose inhaler via an appropriate large volume spacer.

Repeat the salbutamol dose using a nebuliser if there is no improvement.[13]

Evidence: Delivery of beta-2 agonists

In adults with mild to moderate acute asthma exacerbations, a spacer device with a pressurised metered-dose inhaler is as effective as a nebuliser for the delivery of beta-2 agonists. However, there is insufficient evidence for adults with severe and life-threatening asthma, therefore nebulisers are recommended for these patients.

The 2019 joint Scottish Intercollegiate Guidelines Network and British Thoracic Society (SIGN/BTS) guideline on the management of asthma recommends that for adults with mild to moderate asthma attacks, a beta-2 agonist can be given via repeated activations of a pressurised metered-dose inhaler plus spacer.[13] However, due to insufficient data on the use of metered-dose inhalers with spacers in acute severe or life-threatening asthma they recommend, where available, administering beta-2 agonists by wet nebulisation driven by oxygen for these patients.

The underpinning evidence is from a Cochrane systematic review (search date February 2013) in adults (n=729) and children (n=1897) with acute asthma requiring medical assistance.[60]

The Cochrane review included 39 randomised controlled trials (RCTs) comparing delivery of beta-2 agonists via metered‐dose inhaler plus spacer versus nebuliser.
- Settings included the emergency department (31 RCTs), an equivalent community setting (2 RCTs), and inpatients (6 RCTs).
- Treatment with beta-2 agonists was repeated and titrated as required.
- All studies excluded people with life-threatening asthma.
- Results were reported separately for adults and children.
For adults, there was no difference in hospital admission rates (subgroup analysis for adults: RR 0.94, 95% CI 0.61 to 1.43).
- There was also no difference in length of stay in the emergency department (mean difference 1.75 minutes, 95% CI -23.45 to +26.95 minutes).
- Peak flow and forced expiratory volume (FEV1) at 30 minutes or at the end of the study were also similar, including in adults with severe asthma (4 RCTs, n=99, final rise in FEV1 as a percentage of predicted: mean difference -1.60% predicted, 95% CI ‐4.49% to +7.69%).
One small study included in the review was in adult inpatients (n=28). Multiple treatments were allowed including standard doses of intravenous aminophylline and methylprednisolone.
- There was no difference in administering a beta-2 agonist via a metered-dose inhaler plus spacer compared with a nebuliser in mean duration of hospitalisation (n=18, mean difference -0.60 days, 95% CI -3.23 to +2.03 days).
- There were also no significant differences in lung function between groups.

Primary options

salbutamol inhaled: (100 micrograms/dose inhaler) 2-10 puffs inhaled every 10-20 minutes or when required (each puff should be inhaled separately via a large volume spacer); 5 mg inhaled via nebuliser every 20-30 minutes or when required

Plus – systemic corticosteroid

Back

Plus –

systemic corticosteroid

Treatment recommended for ALL patients in selected patient group

Give a corticosteroid as early as possible.[13] The European Respiratory Society/European Academy of Allergy and Clinical Immunology (ERS/EAACI) and GINA recommend doing this within 1 hour.[1][51]

Give oral prednisolone, provided it can be swallowed and retained by the patient.[13]
Consider parenteral hydrocortisone or methylprednisolone as an alternative to oral treatment, where oral treatment is not possible (e.g., the patient is too dyspneic to swallow, is vomiting, or requires non-invasive ventilation or intubation).[1][13]

Do not stop inhaled corticosteroids during prescription of oral or parenteral corticosteroids.[13]

Primary options

prednisolone: 40-50 mg orally once daily for at least 5 days

Secondary options

hydrocortisone sodium succinate: 100 mg intravenously every 6 hours; convert to oral prednisolone as soon as possible to complete course

methylprednisolone sodium succinate: 160 mg intramuscularly (depot formulation) as a single dose

Consider – oxygen

Plus – monitoring and supportive care

ONGOING

symptomatic asthma post-stabilisation

1st line – ongoing care

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1st line –

ongoing care

Continue to monitor signs and symptoms

Continue to monitor symptoms.[13] Continue to record the heart and respiratory rate.[13]

Measure and record peak expiratory flow (PEF) 15 to 30 minutes after starting treatment, and thereafter according to the response.[13] Measure PEF at least 4 times daily during the patient’s hospital stay.[13]

Measure serum potassium and blood glucose concentrations.[13]

If the patient is on aminophylline/theophylline, continue monitoring blood theophylline levels.

Continuing pharmacotherapy

Continue prednisolone (or the alternative parenteral corticosteroid) until recovery (for a minimum of 5 days).[13] Following recovery, corticosteroids can generally be stopped abruptly.[13] In practice, this tends to apply if given for no more than 14 days.

Doses do not need tapering provided the patient receives inhaled corticosteroids.
Taper doses for patients on maintenance corticosteroid treatment or where corticosteroids are required for 3 weeks or more.[13]

Discharge

Consider discharge for the patient who:[13]

Has clinical signs compatible with home management
Is on reducing amounts of a beta-2 agonist (preferably no more than every 4 hours)
Is on medical therapy that they can continue safely at home.

Discharge patients from the emergency department if their peak flow is greater than 75% of best or predicted 1 hour after initial treatment, unless they meet any of the following criteria:[13]

Patient still has significant symptoms
You have concerns about adherence
Patient lives alone or is socially isolated
Patient has psychological problems
Patient has physical disability or learning difficulties
Previous near-fatal asthma attack
Asthma attack despite adequate dose of oral corticosteroid prior to presentation
Presentation at night
Pregnancy.

Do not base the timing of discharge on a single physiological parameter.[13]

Check and record inhaler technique prior to discharge.[1][13] Patients should have been on discharge medication for 12 to 24 hours prior to discharge.[13]

In a recovered patient, aim for a PEF >75% of best or predicted before considering discharge. Agree the patient’s discharge with a respiratory physician if the PEF diurnal variability is >25%.[13]

Consider an extended observation period prior to discharge in all patients who received a nebulised beta-2 agonist prior to presentation.[13]

Generally treatment should be stepped up for a period after an exacerbation (especially if the exacerbation occurred on a background of long term poor asthma control).[1] Arrange the necessary ongoing treatment before the patient goes home.[1] This should include the assessment of preventer (controller) medication with the aim of reducing reliever usage. GINA recommends that patients should resume their normal reliever inhaler before discharge (if a different one was used for acute management) and be transitioned back to as-needed rather than regular use of this, based on symptomatic and objective improvement.[1] Regular use of a short-acting beta-2 agonist inhaler may mask worsening asthma and can increase risk of further exacerbations.[1] In people who present with an exacerbation of undiagnosed asthma, it is recommended to start MART (Maintenance And Reliever Therapy) alongside any treatment for the acute symptoms. This is a combination of Inhaled Corticosteroid with Formoterol). This may be stepped down to ‘as needed’ post discharge.[34] See Follow up.

Ensure the patient has a supply of inhaled corticosteroid and bronchodilator(s), and check and record their inhaler technique.[13]

Arrange a structured review by a member of the specialist respiratory team prior to discharge.[61]

Ensure the patient has a written asthma action plan, has had their inhaler technique assessed, and arrange follow-up with a general practitioner (GP) within 2 working days post-discharge (to further assess and optimise their asthma management).[13][34] Asthma and Lung UK: adult asthma action plan Opens in new window Send a discharge letter to the GP and refer the patient to an asthma liaison nurse or chest clinic.[13] Hospitalised patients should have follow-up with a hospital specialist asthma nurse or respiratory physician approximately 1 month after admission.[13] Work together with the patient to support them and aim to improve their long-term asthma care if needed. See Patient discussions.

Exacerbations are very debilitating for a patient and attempts must be made to break the cycle in patients with recurrent exacerbations.[51]

In the patient with severe asthma and adverse behavioural or psychosocial features, determine the reasons for their exacerbation and send details of their admission, discharge, and potential best PEF to their GP. These patients are at risk of further severe or fatal exacerbations.[13]

In the community: follow-up after treatment or discharge from hospital

Continue prednisolone until recovery (for a minimum of 5 days). Continue to monitor symptoms and PEF.[13]

Arrange early follow-up (within 2 working days) after an exacerbation, regardless of whether it was managed in hospital or in the community.[1][13][34] Work together with the patient to support them and aim to improve their long-term asthma care if needed.

Exacerbations are very debilitating for a patient and attempts must be made to break the cycle in patients with recurrent exacerbations.[51]

You should:[1][13]

Check inhaler technique
Ensure the patient has a written asthma action plan Asthma and Lung UK: adult asthma action plan Opens in new window
- Make sure it is appropriate for their level of control and for their health literacy.[1] This should include how they should respond to worsening asthma. See Patient discussions.
Modify treatment according to guidelines for chronic persistent asthma
Address potentially preventable contributors to hospital admission.

Flag patients identified as being at increased risk of asthma-related death for a more frequent review.[1]

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Acute asthma exacerbation in adults

Treatment algorithm

life-threatening exacerbation or impending respiratory failure

admission to intensive care unit

In the community

oxygen

short-acting bronchodilator

Primary options

Secondary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

systemic corticosteroid

Primary options

Secondary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

supportive care

magnesium sulfate

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

aminophylline

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

mechanical ventilation

antibiotic therapy

acute severe exacerbation

short-acting bronchodilator

In the community

Pregnancy

Primary options

Secondary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

oxygen

systemic corticosteroid

Primary options

Secondary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Secondary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Secondary options

supportive care

monitoring

magnesium sulfate

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

antibiotic therapy

moderate exacerbation

short-acting bronchodilator

Evidence: Delivery of beta-2 agonists

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

systemic corticosteroid

Primary options