Acute Severe Bronchial Asthma Guideline [2025]

Emergency Management of Acute Severe Bronchial Asthma is discussed here. Hospital Admission, Discharge, and Outdoor treatment are described with medicine names.

Acute Severe Bronchial Asthma is a Life-Threatening condition for patients. Whenever A patient comes to you with, complains you with Bronchial Asthma. First, Look for whether it is Acute severe asthma or not.

Acute severe asthma criteria

• PEF 33–50% predicted (< 200L/min)

• Respiratory rate of 25 breaths/min

• Heart rate 110 beats/min

• Inability to complete sentences in 1 breath

It is called an immediate assessment of Acute severe asthma. Davidson Chart Box 19.25 defines that.

Differential Diagnosis of Acute severe asthma

1. Congestive Heart Failure – Check for Lung basal crepitation
2. COPD – Chronic Obstructive Pulmonary Disease
3. Pulmonary Infection ( Eg: Strongyloidiasis, Aspergillosis)
4. Pulmonary Embolism
5. Foreign Body Aspiration
6. Churg-Strauss Syndrome

Rx Treatment Of Acute severe asthma – Admission

• Diet – Full
• Bed rest in a propped position
• O2 Inhalation 4L/Min
• Nebulization with Windel Plus Soln. (2.5ml)

Each ampoule Windel Plus contains 2.5 ml isotonic, transparent solution for inhalation of salbutamol sulfate BP equivalent to Salbutamol 2.5 mg and Ipratropium Bromide BP equivalent to Ipratropium 0.5 mg.

• Tab. Doxophylline 400mg ( Incepta – Brezofil, Beacon-Doxoven, Doximar, Docopa, Square- Flindof)
  • 1+0+0
  • ^₁/^₂ + 0 + ¹/₂

Child: Children >12 years – 200 mg 2 or 3 times daily. (½ tablet b.i.d/ t.i.d)

• Injection Hydrocortisone (2ml-10mg) (Cotson – Opsonin)
  • 1 Vial I/V Stat then 1 Vial I/V 6 Hourly

Discharge R_x of Acute severe asthma or Outdoor Treatment of Acute severe asthma

• Antibiotic – (Quinolones) Tab. Levofloxacin (500mg) (Ovel, Trevox, Evo, Leo) 0+0+1 – 7 Days
• Anti Ulcerant (Esomeprazole) Cap. Esoral, Tab. Esotid, Cap. Exium (20mg) 1+0+1 – 7 Days
• Tab. Prednisolone 20mg (Precodil, Cortan) 1+0+0 (after meal) – 7 Days (0.5-1ml/Kg)
• Tab. Doxophylline 400mg ( Incepta – Brezofil, Beacon-Doxoven, Doximar, Docopa, Square- Flindof)

  • See Doxofylline – Indication, Dosage, Adverse Effect, Drug Interaction

1+0+0

^₁/^₂ + 0 + ¹/₂

Child: Children >12 years – 200 mg 2 or 3 times daily. (½ tablet b.i.d/ t.i.d)

• Inhaler Beclomethasone dipropionate (Square-Beclomin, Beximco-Decomit) HFA 100,250 mcg
  • 2 Puff TDS (Gargle with water after use)
• Inhaler Salbutamol (*GSK-Ventolin, Beximco-Azmasol, Asmalin) HFA 100mcg/puff
  • 2 Puff TDS 7 Days after that SOS

Or,

• Inhaler Salmeterol + Fluticasone (50mcg + 250mcg) (Ticamet-Square, Bexitrol-F 50/250)
  • 2 Puff TDS (Gargle with water after use)
• Dry Powder Inhalation Capsule (Windel ConviCap)
  • 2 Puff TDS 7 Days after that SOS

How to take Dry Powder Inhalation Capsule

• Tab. Montelukast (10mg) (Monas – Acme, Odmon – Renata, Telukast – General)
  • 1+0+0 – Continue

If Child:

• Syp. Levostar (1mg/5ml)
  • 1-2 TSF three times daily.
• Tab. Montelukast (4mg) (Monas – Acme, Odmon – Renata, Telukast – General)
  • 1+0+0 – Continue

*GSK – GlaxoSmithKline Bangladesh Limited

If you want to add any drugs that will work better for asthma, feel free to discuss that in the Comments Section.

Advice For Test

1. CBC
2. Chest X-Ray P/A View (100% Digital)
3. ECG
4. Arterial Blood Gas Analysis