Step 1 : SABA prn If exercise induced take 10 min before exercise. Step 2: Low dose ICS or leukotriene inhibitor or Cromonlyn Step 3: Low dose ICS + LABA +/- Leukotriene Inhibitor or Med dos e ICS Step 4 Med to High dose ICS + LABA + Leukotriene Inhibitor
1. Life threatening asthma exacerbation, 2. Hospitalization 3. Step 4 or higher treatment 4. Comorbidities, 5. Need for additional testing ( skin test or complete PFT) 5. Candidate for immunotherapy or biologics.
Def: Decrease of 20% PEF . If PEF < 50% to ER. SABA 4-6 inhalations Q 10-20 min x 3 . PEF 50-70% (incomplete response) Repeat SABA 20 min x 3 and reassess. If PEF > 80 good response and can lengthen SABA Q 3hours. If no improvement start oral steroids and continue with SABA Q3. Seek medical attention if not improved.
Assess sx and severity. To ED if unable to speak full sentence, breathless at rest or drowsy or agitated, PEF < 50%, HR > 120, RR > 30 , O2 < 90. Start Albuterol Neb Q 20 min x 3 (Consider co neb with ipratropium) , oral prednisone 40 mg. If improved with PEF 60-80% and O2 > 94 Ok to go home. Continue with SABA Q 3-4 hours, ICS, oral steroids, and avoid triggers. Instruction to go to ED if worse.