Treatment of exacerbations

A personalised asthma action plan should identify what to do in the event of worsening symptoms and how to prevent deterioration using the individual’s own inhaler devices, highlighting when emergency care is required. Patients should be encouraged to continue to use their usual inhaler device in an acute exacerbation as this is the device that they will have been taught to use effectively and will be confident in using.

During acute exacerbations, treatment is with repeated administration of SABA, early introduction of oral corticosteroids, and controlled flow oxygen where indicated.

Inhaled SABA therapy such as salbutamol should be administered frequently for patients presenting with acute asthma. Delivery of SABAs via a pMDI and spacer or a DPI leads to a similar improvement in lung function as delivery via a nebulizer for treatment of acute exacerbations.²⁶ A person-centred approach to treatment plans for acute exacerbations should be taken to ensure that the individual has a reliever inhaler that they can use effectively in the event of an acute attack. If a patient has concerns regarding their ability to use their usual inhaler device during an exacerbation, this should be discussed and a person-centred choice made.

Refer to local acute protocols for management of acute asthma exacerbations in a secondary care setting, including use of agents such as intravenous (IV) magnesium sulfate and aminophylline etc.