Severe episode:

1. SEVERE wheezing
2. SEVERE difficulty breathing

Rib retractions
Nasal flaring
Use of accessory muscles
Cyanosis

PEFR: 33-50%
RR: > 25/min
HR: > 110/min
Spo2: <92%

3. Inability to speak in complete sentence interrupted by

breathing
4. Inability to lie down
5. Sharp chest pain when taking a breath, coughing
6. Altered conscious level.

 HIGH FLOW O2 to maintain Spo2 94-98% using

face mask or nasal cannula.
Nebulized B2 agonist(5mg) with O2, repeated
10-20 mins intervals.
Nebulized ipratropium bromide(500mcg) 4-6 hrs.
Steroid therapy: I.V. hydrocortisone 100-200mg.
Adrenaline(1:1000) used only for allergic and
anaphylactic reactions.
Refer any patients requiring ventilatory support
or having life threatening asthma with poor
response.
In Pregnancy: Give drug therapy for acute
asthma as for the non-pregnant patient with
continuous fetal monitoring.