Algorithm
- ABC; high-flow oxygen target SpO₂ 94–98%; peak flow if possible.
- Back-to-back salbutamol nebulizers (5 mg) + ipratropium 500 mcg.
- Prednisolone 40–50 mg PO/IV early; magnesium sulfate 2 g IV if severe.
- Reassess q15–30 min; admit ICU if deteriorating or silent chest.
- Consider IV salbutamol/aminophylline in refractory cases (specialist).
Red flags
- • Silent chest, exhaustion, rising PaCO₂, or SpO₂ falling despite oxygen
- • Need for intubation — call critical care early
- • Anaphylaxis overlap — consider IM adrenaline
Medications by step
Step 1 — Bronchodilators
- Salbutamol · inhaled
5 mg nebulized q20 min ×3, then hourly PRN
- Ipratropium · inhaled
500 mcg nebulized with salbutamol
Step 2 — Systemic steroids
- Prednisolone · p.o./i.v.
40–50 mg PO/IV
Step 3 — Severe adjunct
- Magnesium sulfate · i.v.
2 g IV over 20 min
References
- • GINA 2025 — Difficult-to-treat / severe asthma & acute care principles; BTS/SIGN (2025)
Updated: Июль 2026