F00574 019 f025

MEASURE PEAK EXPIRATORY FLOW

Convert PEF to % best or % predicted

Life-threatening/acute

______seyere

Arterial blood gas Nebulised salbutamol 5 mg or terbutaline 2.5 mg 2-4-houily or as required Oxygen—high-flow/60% Prednisolone 40 mg orally (or hydrocortisone 200 mg i.v.)

Moderate

Arterial blood gas Nebulised salbutamol 5 mg or terbutaline 2.5 mg Oxygen—high-flow/60% Prednisolone 40 mg orally

Mild

Did patient receive nebulised therapy before PEF recorded?

(|)

I

Wait 30 mins <+

Usual inhaled bronchodilator Wait 60 mins

ł

Mcasure PEF

Home

Ir

l.v. access, CXR, plasma theophylline level, plasma K*

PEF < 60% predicted

•    Usual treatment

•    Return immediately if worse ■ Appointment with GP within 48 hrs

Admit

•    Administer repeat salbutamol 5mg + ipratropium bromide 500 pg by oxygen-driven nebuliser

•    Consider continuous salbutamol nebuliser 5-10 mg/hr

•    Consider i.v. magnesium sulphate 1.2-2.0g over 20 mins. or aminophylline 5 mg/kg loading dose over 20 mins followed by a continuous infusion at 1 mg/kg/hr

•    Correct fluid and electrolytes (especially K^ł)

PEF > 60% predicted

%

Home

¹ Check with senior medical Staff ¹ Prednisolone 40 mg daily for 5 days ¹ Start or double inhaled corticosteroids ¹ Return immediately if worse ¹ Appointment with GP within 48 hrs

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