Management of an acute asthma attack

Despite a more proactive approach to asthma management, which includes an increased range of drugs, wide dissemination of guidelines, and the use of asthma action plans, an acute severe asthma attack is one of the most common emergencies a general practitioner will encounter.

This article discusses the management of an acute asthma attack in the general practice setting.

Assessment of severity is vital and can be ascertained quite quickly with a brief history and rapid physical examination. It is important to remember that wheeze is an unreliable indicator of the severity of attack and may be absent in severe asthma. The cornerstones of treatment are oxygen and inhaled beta 2 agonists. Beta 2 agonists can be given continuously in severe life threatening asthma. Early administration of systemic steroids is important. Patients discharged to home after treatment of an asthma attack require close follow up including beta 2 agonists for symptom control, review of medications including a consideration of a short course of oral steroids, a written asthma action plan and detailed advice about what to do in case of deterioration in the next 24 hours. They should be reviewed in 24-48 hours.