Asthma Consult Checklist – Flareups

Download Asthma Consult Checklist – Flare Ups

Explanatory notes and References

Explanatory notes:

  1. Such as worsening of symptoms over hours or days, or needing a reliever again within a few hours.3
  2. Patients require clear instructions in their written asthma action plan about how to monitor symptoms and recognise flare ups. Advise that inhaled short-acting beta2 agonists may have reduced effectiveness during viral infections.3
  3. Even if they need oral corticosteroids.3
  4. To increase the amount of medication deposited within the airways.3
  5. For example, contact a GP or start a course of oral corticosteroids if prescribed.3
  6. Or as instructed in their written asthma action plan.3
  7. When prescribing oral corticosteroids, the recommended daily dose is oral prednisolone 37.5–50mg for 5–10 days. It is usually not necessary to taper the dose for courses <14 days.3
  8. For patients measuring peak flow each day (determine level based on personal best and history of peak flow levels before and during flare ups).3
  9. The recommended dose for a non-emergency bronchodilator in children aged 6–11 years is 2–4 puffs of salbutamol 100µg/actuation as needed, 1 puff at a time (taken via a pressurised metered-dose inhaler plus spacer), and repeated 4 hours later, if needed. Another option for children aged 6–11 years is 1–2 puffs of terbutaline 500µg/actuation (taken via a dry-powder inhaler), assuming they can use a dry-powder inhaler correctly.4 The recommended dose for a non-emergency bronchodilator in children aged 1–5 years is 2–4 puffs of salbutamol 100µg/actuation as needed, 1 puff at a time (taken via a pressurised metered-dose inhaler plus spacer and face mask for infants aged 1–2 years or pressurised metered-dose inhaler plus spacer for children aged 3–5 years if they are able to cooperate).5
  10. Montelukast, an inhaled corticosteroid, or a combination of an inhaled corticosteroid and a long-acting beta24
  11. For recommendations on stepping up or stepping down treatment, see the Australian Asthma Handbook including Stepped approach to adjusting asthma medication in adults and adolescents,7 Stepped approach to adjusting asthma medication in children aged 6–11 years,8 and Stepped approach to adjusting asthma medication in children aged 1–5 years.8
  12. For example, 1mg/kg prednisolone up to a maximum of 50mg each morning for 3 days.5
  13. Such as a respiratory physician or paediatrician.4,5
  14. For example, continue for 7 days or until symptoms have resolved for 48 hours.5
  15. To check asthma control, adherence and inhaler technique.4
  16. Including taking preventer medications every day, if prescribed.4

Key Australian Asthma Handbook resources:

  • Figure: Managing acute asthma in adults.2
  • Figure: Managing acute asthma in children.2
  • Figure: Stepped approach to adjusting asthma medication in adults and adolescents.7
  • Figure: Stepped approach to adjusting asthma medication in children aged 6–11 years.8
  • Figure: Stepped approach to adjusting asthma medication in children aged 1–5 years.8
  • Table: Checklist for reviewing a written asthma action plan.9
  • Table: Classification of preschool wheeze and indications for preventer treatment in children aged 1–5.8
  • Table: Definition of levels of recent asthma symptom control in adults and adolescents (regardless of current treatment regimen).9
  • Table: Definition of levels of recent asthma symptom control in children (regardless of current treatment regimen).10
  • Table: Management of risk factors for adverse asthma outcomes in adults.9
  • Table: Options for adjusting medicines in a written asthma action plan for adults.9
  • Table: Risk factors for adverse asthma outcomes in adults and adolescents.9
  • Table: Severity classification for flare-ups (exacerbations).3

References

  1. National Asthma Council Australia. Australian Asthma Handbook. Available at: asthmahandbook.org.au. Accessed March 2020.
  2. National Asthma Council Australia. Australian Asthma Handbook. Managing acute asthma in clinical settings. Available at: https://www.asthmahandbook.org.au/acute-asthma/clinical. Accessed March 2020.
  3. National Asthma Council Australia. Australian Asthma Handbook. Managing flare-ups in adults. Available at: https://www. org.au/management/adults/flare-ups. Accessed March 2020.
  4. National Asthma Council Australia. Australian Asthma Handbook. Managing flare-ups in children aged 6 years and over. Available at: https://www.asthmahandbook.org.au/management/children/6-years-and-over/flare-ups. Accessed March 2020.
  5. National Asthma Council Australia. Australian Asthma Handbook. Managing flare-ups in children aged 1–5 years. Available at: https://www.asthmahandbook.org.au/management/children/1-5-years/flare-ups. Accessed March 2020.
  6. Australian Government Department of Health Therapeutic Goods Administration. Montelukast. Available at: https:// tga.gov.au/alert/montelukast. Accessed March 2020.
  7. National Asthma Council Australia. Australian Asthma Handbook. Managing asthma in adults. Available at: https://www. org.au/management/adults. Accessed March 2020.
  8. National Asthma Council Australia. Australian Asthma Handbook. Managing asthma in children. Available at: https://www. org.au/management/children. Accessed March 2020.
  9. National Asthma Council Australia. Australian Asthma Handbook. Conducting asthma review at scheduled asthma visits. Available at: https://www.asthmahandbook.org.au/management/adults/reviewing-asthma/scheduled-asthma-visits. Accessed March 2020.
  10. National Asthma Council Australia. Australian Asthma Handbook. Planning and conducting routine asthma review for children. Available at: https://www.asthmahandbook.org.au/management/children/routine-asthma-reviews. Accessed March 2020.