Management of Acute Severe Asthma in Adults in A&E
N.B. The flowchart has been adapted for local use. The original flowchart is available at: Scottish Intercollegiate Guidelines Network (SIGN). British guideline in the management of Asthma. Edinburgh: SIGN; 2019 (SIGN publication no. 158). Available from www.sign.ac.uk.
All changes in the flowchart and in the notes below have been denoted by # and should not be taken as an endorsement by the original authors.
Notes on Potential Discharge from A&E
- Patients should be monitored closely after initial treatment to ensure sufficient clinical improvement prior to consideration of discharge.#
- In all patients who received nebulised beta2 agonists prior to presentation, consider an extended observation period prior to discharge.#
- If PEF <50% on presentation, prescribe prednisolone oral 40-50mg/day for a minimum of 5 days.#
- Ensure all patients have a supply of inhaled steroid and beta2 agonist and check inhaler technique.#
- Consider if adverse psychological factors (e.g. severe mental health issues, social isolation) may impact on safety of discharge and if so consider admission for observation for 24 hours.#
- Arrange GP follow up within 2 working days post discharge.#
- Ensure patient's electronic discharge letter is completed.#
- Refer to asthma liaison nurse / chest clinic.
Peak Expiratory Flow Rate - Normal Values
For peak expiratory flow chart, see SIGN 158 Annex 4 at www.sign.ac.uk.
Guideline reviewed and updated June 2021