Asthma Exacerbations

Action

• Obtain initial history (including detailed asthma history) and physical examination
• Obtain vital signs, including oxygen saturation, heart rate, and respiratory rate
• Consider end-tidal carbon dioxide (ETCO2) monitoring

Decision

What is the severity of the asthma exacerbation?

Mild

Moderate

Severe

Background

Mild

• Mild end-expiratory wheezing only
• Oxygenation >95%
• Minimal to no use of accessory muscles
• Vital signs within normal limits
• Speaking in full sentences
• FEV1 or PEF >70% predicted

Moderate

• Oxygenation >90%
• Accessory muscle usage but still able to speak
• Elevated respiratory rate
• Elevated heart rate
• FEV1 or PEF 40%-69% predicted

Severe

• Oxygenation <90%
• Significant accessory muscle usage
• Vital signs with significant stress
• Altered mental status
• FEV1 or PEF <40% predicted

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Emergency Department Management of Acute Asthma Exacerbations | EB Medicine

About This Issue Case Presentations Introduction Critical Appraisal of the Literature Epidemiology Prevalence of Asthma and Healthcare Costs Social Determinants and Risk Factors Etiology and Pathophysiology Differential Diagnosis Congestive Heart Failure Chronic Obstructive Pulmonary Disease Pneumonia/COVID-19 Pulmonary Embolism Other Conditions in the Differential for Asthma Prehospital Care Emergency Department Evaluation

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Full Asthma Exacerbation Pathway

Mild

Moderate

Severe