Well done, your treatment of acute severe asthma is spot on:

• Oxygen, to target sats of 94-98%
• Salbutamol 5mg nebulisers QDS regular and PRN
• Ipratropium bromide 500mcg nebulisers QDS
• Oral prednisolone 40-50mg for 5 days or IV hydrocortisone 100-200mg
• Further treatment by seniors (such as magnesium sulphate) only if failure to respond and with a referral to ITU

The salbutamol nebs work wonders to relieve your patient’s airway obstruction and she soon walking around and looking for you to thank you.

Feeling happy with yourself, you document that she needs to be stable off nebulisers for 24 hours before discharge, needs inhaler technique review and should go home with a clear asthma action plan with review by the respiratory team within 1 week. Prevention is better than cure – you don’t want to have to deal with another of her acute attacks again anytime soon!

See what the experts advise us on pages 18-19 of the BTS guidelines.