The nurse comes over: “5mg of ipratropium doesn’t fit in the nebuliser, do you want me to just keep giving it 0.5mg at a time?” Alarmed, you amend your prescription before somebody else finds out about your mistake. Your cross out the previous one and prescribe ipratropium bromide 500mcg nebulisers QDS.

The nurse administers the salbutamol and this works wonders to relive your patient’s airway obstruction. You also give the patient a course of steroids to reduce inflammation.

Crisis averted, 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.