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Asthma Attack (Exacerbation): Recognition, Immediate Action, and Prevention

An asthma exacerbation is acute worsening of bronchoconstriction, inflammation, mucus plugging → airflow obstruction.

Red Flags (Severe/Life-Threatening)

  • Inability to speak full sentences.
  • SpO₂ <92%, silent chest, cyanosis, exhaustion, confusion, PEF <33% predicted.

Immediate Action (Home/Pre-hospital)

  1. SABA: Albuterol 4–10 puffs via spacer (repeat q20min × 3).
  2. Systemic corticosteroids: Prednisone 40–60 mg PO (if prescribed/action plan).
  3. Call 911 if no improvement after 1st SABA round, or any red flag.

ED Management

  • Continuous/nebulized SABA + ipratropium.
  • IV magnesium sulfate, IV corticosteroids.
  • BiPAP/Intubation for respiratory failure.

Prevention

  • Controller therapy (ICS/LABA, LAMA, biologics) per GINA stepwise.
  • Written asthma action plan.
  • Trigger avoidance, inhaler technique, adherence monitoring.
  • Annual flu/COVID vaccines.

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