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Box 60.2

Pitfalls in the Management of Acute Asthma

  • Be vigilant for pneumothoraces; small ones may be difficult to detect.
  • Beware of the tiring patient. Escalate treatment and involve the ICU team if:
    • Wheeze disappears: this is a silent chest not an improvement in symptoms
    • PaCO2 normalizes
  • If you are giving a one-off stat dose of IV hydrocortisone, ensure you give a dose of oral prednisolone also.
  • Ensure at discharge that:
    • Inhaled corticosteroid is started in addition to a course of oral steroids
    • Inhaler technique is checked
    • Smoking cessation advice given if necessary
    • A peak flow meter is given to continue monitoring
    • Specialist follow-up is arranged (urgently for those with an acute, severe or life-threatening episode)