Asthma (Acute) - Management Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • The management of acute asthma

This guidance does not cover:

  • Acute presentation of Lower Respiratory Tract Infection.
  • Children 12 years or under

Assessment

Many deaths are preventable. Factors leading to poor outcome include:

  • Failure by clinical staff to objectively assess severity
  • Patients or relatives failing to appreciate severity
  • Under-use of corticosteroids

Assessment

  • Assess to determine severity
  • Record Peak expiratory flow rate (PEFR), heart rate, respiratory rate, oxygen saturations (SpO2)
  • complete a clinical examination

See Acute management guidelines Algorithm to determine outcome of assessment

Red flags

999/Admit immediately if:

  • Severity is Acute Severe or Life threatening
  • Any life threatening features
  • Any features of acute severe asthma after initial treatment
  • Previous near fatal asthma attack
  • Lower threshold for admission if
    • Afternoon or evening attack
    • Recent nocturnal symptoms or hospital admission
    • Previous severe attacks
    • Patient unable to assess own condition or concern over social circumstance

Management

Treat

  • According to severity

Reassess response to therapy after 30 mins

Refer

  • To hospital any patients with features of acute severe or life-threatening asthma

Educate & Follow-up ensuring that:

  • All patients should be reviewed by appropriate health care professional within 2 working days of acute treatment, including discharge from the Emergency Department.
  • Patient is taking a regular inhaled corticosteroid.
  • Inhaler technique is checked and is satisfactory.
  • Medicines are explained and understood by the patient and/or carer
  • Self-Management education including written Asthma Control Plan, and rescue medication* is provided.
  • Treatment is in accordance with BTS and Local guidelines and appropriate to severity of condition see Asthma - Preferred treatment (Pharmacological Management) Guidelines
  • Provide Asthma UK. " Your asthma attack recovery plan" leaflet
  • Advice is given to stop smoking and reduce exposure to cigarette smoke, Arrange referral to stop smoking service - see smoking cessation care pathways
  • Potentially preventable contributors to recent exacerbation is discussed and addresssed
  • Patient is given clear instructions and understands what action to take if symptoms deteriorate

*Rescue medication - 7 day supply of once daily 40mg oral steroids to commence in event of agreed symptom deterioration


Referral

Referral Criteria

  • Immediate/999 referral for patients with features of acute severe or life-threatening asthma - please see Acute management guidelines algorithm for further guidance relating to severity of condition
  • Patients with moderate asthma who meet the criteria identified in the Acute management guidelines algorithm should be admitted after discussion with the GP line (01924 543995) by clinically appropriate transport methods

Referral requirements

  • Information re identified red flags

Supporting information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation. Please support the development of a personalised Asthma Control Plan to support shared decision making and self care

Patient information/Public Health/Self Care

Evidence/Additional Information

Assurance & Governance

  • This guidance was developed on: 03.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 08.2017
  • Publication Date: 08.2017
  • Review Date: 03.2019
  • Ref No: RS7 - 03.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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