How do you manage Acute exacerbation of Bronchial Asthma?

Firsth, to apply oxygen with one of short acting bronchodilator (salbutamol or two-compoudents drug with fenoterol and ipratropium bromid as Berodual). The short acting bronchodilator as salbutamol to repeat 3 times at every 20 minutes during first hour of tretament. After that to make new assessment of patient' clinical state and to continue with treatment at home if patient had sufficient response to short acting bronchodilatator or to continue with repeated dose of salbutamol during next 1-2 hours to total 10 doses of salbutamol. If patient show very severe asthma attack during first hour of treatment the indication is to applicate salbutamol with ipratropium bromid. During second hour of tretament it is necessary to applicate to this patient, orally, prednisolon in dose of approx. 0,5-1 mg per kilograms of body weight. The replacement for prednisolon would be intravenous metilprednisolon in the mentioned doses. If patient show severe or very severe asthma exacerbation during second hour of treatment exist the indication to continue with inhalation of ipratropium bromid (Atrovent). If patient and further shows severe or very severe asthma attack it is advisable to add magnesium sulfate, intravenousely, in dose of 25-50 mg/kg every 6 hours with measuring of the concentration of blood magnesium. If patient and furthere shows severe or very severe asthma attack the indication is to applicate aminophyllinum, intravenously, in daily dose of 12-24 mg/kg divided to 3 or 4 single doses. All time for this patients to apply oxygen in a concentration that reach percutaneous saturation more than 94%. Of course, if the patient isn't well after the first hour of treatment he must be situated in the unit of intensive care. All the time, recognize patients follow to inhale their inhaled steroids in recommended doses od 2-4 times higher doses than recommended doses. During first hour of treatment recognized asthmatic patient the indication is to inhale his/her inhaled steroid. 

Asthma exacerbations consist of acute or subacute episodes of progressively worsening shortness of breath, coughing, wheezing, and chest tightness or any combination,take vital signs puls oximeter and asses severity of attack . RISK FACTORS FOR DEATH FROM ASTHMA 

Asthma history  Previous severe exacerbation (e.g., intubation or ICU admission for asthma)  Two or more hospitalizations for asthma in the past year  Three or more ED visits for asthma in the past year  Hospitalization or ED visit for asthma in the past month  Using > 2 canisters of SABA per month  Difficulty perceiving asthma symptoms or severity of exacerbations  Other risk factors: lack of a written asthma action plan, sensitivity to Alternaria Social history  Low socioeconomic status or inner-city residence  Illicit drug use  Major psychosocial problems Comorbidities  Cardiovascular disease  Other chronic lung disease  Chronic psychiatric disease

Oxygen therapy, Inhaled beta 2 agonist 3 sessions 20 minutes apart if patient dosent respond then Inhaled /systemic corticosteroids ,

nebulization by salbutamol         ......2.Hydrocortisone      .....3..Ipratropium promide.....4  magnesium sulphate ....5  amino philine....6  intupation