Admit to hospital intensive care (see box below) Repeat assessment Symptoms, physical examination, PEF, O2 saturation, other tests as needed Good response  FEV1 or PEF ˜70%  Response sustained 60       minutes after last treatment  No distress      Physical exam: normal Incomplete response  FEV1 or PEF 40–69%  Mild-to-moderate symptoms Poor response  FEV1 or PEF <40%  PCO2 ˜42 mm Hg      Physical exam:       symptoms severe,       drowsiness, confusion Individualized decision re: hospitalization (see text) Discharge home  Continue treatment with inhaled SABA  Continue course of oral       systemic corticosteroid  Consider initiation of an ICS      Patient education         Review medications, including inhaler technique         Review/initiate action plan Recommend close medical           follow-up Admit to hospital ward  Oxygen  Inhaled SABA      Systemic (oral or intravenous)       corticosteroid  Consider adjunct therapies      Monitor vital signs, FEV1 or       PEF, SaO2 Improve Improve Admit to hospital intensive care  Oxygen      Inhaled SABA hourly or       continuously      Intravenous corticosteroid  Consider adjunct therapies      Possible intubation and       mechanical ventilation Discharge home      Continue treatment with inhaled SABAs.      Continue course of oral systemic corticosteroid.      Continue on ICS. For those not on long-term-control therapy, consider       initiation of an ICS.      Patient education (e.g., review medications, including inhaler technique:       review/initiate action plan and, whenever possible, environmental control       measures; and recommend close medical follow-up).      Before discharge, schedule follow-up appointment with primary care provider       and/or asthma specialist in 1–4 weeks. Key: FEV1, Forced expiratory volume in 1 second; ICS, inhaled corticosteroid; MDI, metered-dose inhaler; PCO2, partial pressure carbon dioxide; PEF, peak expiratory flow; SABA, short-acting beta2-agonist; SaO2, oxygen saturation Figure 78-4 Management of asthma exacerbations: emergency department and hospital-based care. (From National Heart Lung Blood Institute, National Asthma Education and Prevention Program: Expert panel report 3: guidelines for the diagnosis and management of asthma. Summary report 2007, NIH Publication No. 08-5846, Bethesda, MD, 2007, U.S. Department of Health and Human Services, p 55, http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf
Figure 78-5 Asthma self-management guideline. (From National Heart Lung Blood Institute, National Asthma Education and Prevention Program: Expert panel report 3: guidelines for the diagnosis and management of asthma. Summary report 2007, NIH Publication No. 05-5251, Bethesda, MD, 2007, U.S. Department of Health and Human Services, p 119, http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
For: Doctor: Date: Doctor’s Phone Number Hospital/Emergency Department Phone Number
Doing Well Take these long-term-control medicines each day (include an anti-inflammatory).
No cough, wheeze, chest tightness, or Medicine How much to take When to take it shortness of breath during the day or night Can do usual activities
And, if a peak flow meter is used, Peak flow: more than Identify and avoid and control the things that make your asthma worse, like (list here): (80 percent or more of my best peak flow)
My best peak flow is: Before exercise, if prescribed, take: 45 to 60 minutes before exercise