Hospital Management

FEV 1 or PEF >= 40%

• O2
• SABA (INH or MDI) Up to 3 doses in 1st hour
• PO Corticosteroids (lack of response, recent PO corticosteroids)

Hospital Management

< 40% (Severe)

• O2, High dose SABA + ipratropium (INH or MDI) q20min or continous for 1 hour
• PO Corticosteroids

Hospital Care

Impending or actual resp. arrest

• Intubation with O2
• Nebulized SABA and Ipratropium
• IV Corticosteroids
• Admit to hospital ICU

Hospital care

After Repeat Assessment (FEV1 or PEF 40-69%)

• PE: Moderate symptoms
• Inhaled SABA Q 60min
• Continue 1-3 hours if improvement
• Make admit decision < 4 hours

Hospital Care

Repeat Assessment (FEV1 or PEF < 40 %)

• PE: Severe symptoms at rest, accessory muscle use
• Hx: high risk patient
• No improvement after initial treatment
• Oxygen
• Nebulized SABA + ipratropium, hourly or continuous
• Oral corticosteroids

3rd Tier: Good Response

FEV1 or PEF > 70%

• Response sustained 60 minutes
• no distress
• PE: Normal
• Discharge: SABA, PO Corticoid, possibly ICS

Hospital Care

3rd Tier - incomplete

FEV1 or PEF 40-69%

• Mild-to-moderate symptoms
• Individualized decision
• DC: SABA, PO corticoid, Possibly ICS
• Admit to floor and intiate O2, inhaled SABA, systemic corticoid

3rd tier

poor response

FEV1 or PEF <40

• PCO2 > 42 mmHg
• PE: Severe symptoms Drowsiness and confusion
• Admit to ICU and initiate O2, SABA hourly or cont., IV Corticoid, possible intubation and mechanical ventilation