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)