Treating Asthma

Home Management

When treating asthma, a high risk of a fatal outcome requires immediate medical care and treatment. Risk factors include:

  1. Asthma Factors:
    1. Previous intubation and ICU treatment
    2. Two (2) or more hospitalizations for asthma in the past year
    3. Three (3) or more emergency room (ER) visits in the past year
    4. Hospitalization or ER visit in the past month
    5. Using more than 2 canisters of SABA per month
    6. Difficulty perceiving asthma symptoms or severity of asthma exacerbations
    7. Other risk factors: lack of written asthma plan, sensitivity to Alternaria
  2. Social history:
    1. Low socioeconomic status or inner-city residence
    2. Illicit drug use
    3. Major psychosocial problems
  3. Co-morbidities
    1. Cardiovascular disease
    2. Other chronic lung disease
    3. Chronic psychiatric disease

Severe signs and symptoms:

  1. Severe breathlessness
  2. Inability to speak
  3. Sleepiness
  4. Use of accessory muscles of respiration

Peak expiratory flow rate (PEFR) values:

  1. If 50 to 79% of predicted – need quick-relief therapy
  2. If less than 50% of predicted or personal best – need immediate medical care


  1. Inhaled SABA


  1. Good response:
      No wheezing or dyspnea
    1. PEFR 80% or greater than predicted or personal best
    2. Contact physician
    3. Continue SABA as per physician
    4. Use a short course of oral corticosteroids as per physician
  2. Incomplete response:
    1. Persistent wheezing and dyspnea
    2. PEFR 50 to 79% of predicted or personal best
    3. Contact physician urgently
    4. Continue SABA
    5. Start oral corticosteroids
  3. Poor response:
    1. Marked wheezing and dyspnea
    2. PEFR less than 50% of predicted or personal best
    3. Repeat SABA right away
    4. Add oral corticosteroids
    5. If distress is severe and non-responsive to initial therapy call 9-1-1 and go to ER

I highly recommend checking out Figure 5-6 of the free PDF Management of Exacerbations of Asthma in Home, Emergency Room and In Hospital available from National Heart, Lung, & Blood Institute. Go to the 16th page (p. 388 of the entire report)

Management of Asthma Exacerbations: Emergency Department and Hospital-Based Care


This Treating Asthma presentation is modeled in part after the following:

National Asthma Education and Prevention Program
Expert panel Report 3:
Guidelines for the Diagnosis and Management of Asthma
Full Report 2007

U. S. Department of Health and Human Services
National Institutes of Health
National Heart, Lung and Blood Institute

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