Emergency MedicineRespiratory
Acute Asthma in Adults
Assessment and management of acute asthma exacerbations, severity classification, and escalation criteria.
Source: BTS/SIGN British Guideline on Asthma 2019; NICE NG80
Used in: Asthma
Step 1 of ~9
action
Immediate Assessment
Measure and document:
• Peak expiratory flow (PEF) — compare to personal best or predicted
• SpO₂ (target 94–98%)
• Respiratory rate, heart rate, accessory muscle use, ability to speak
• Pulsus paradoxus (if available)
• CXR if: first presentation, suspected pneumothorax, no response to treatment
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Magnesium Sulphate IV (Acute Asthma) · Bronchodilator / Smooth muscle relaxant
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Sodium Chloride 3% (Hypertonic Saline) · Hypertonic Electrolyte Solution — ICP/Hyponatraemia Management
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
Pathways
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
A deeper exam-focused version of this pathway is available on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only. Always apply local guidelines and clinical judgement.