## Acute Asthma Exacerbation Management This patient presents with a **moderate-to-severe acute exacerbation** (peak flow 55% of personal best, oxygen saturation 92%, dyspnea at rest). The immediate management requires rapid anti-inflammatory and bronchodilator therapy. **Key Point:** Acute asthma exacerbations require **simultaneous systemic corticosteroids and rapid-acting bronchodilators**, not just dose escalation of maintenance therapy. **High-Yield:** GINA acute exacerbation management algorithm: ```mermaid flowchart TD A[Acute asthma exacerbation]:::outcome --> B{Severity assessment}:::decision B -->|Mild-Moderate| C[SABA + systemic corticosteroids]:::action B -->|Severe| D[SABA + systemic corticosteroids + oxygen]:::action C --> E[Assess response at 1 hour]:::decision D --> E E -->|Good response| F[Discharge with follow-up]:::action E -->|Poor response| G[Consider ICU/hospital admission]:::urgent ``` ### Acute Exacerbation Treatment | Component | Rationale | |-----------|----------| | **SABA (albuterol/salbutamol)** | Rapid bronchodilation; give 2–4 puffs every 20 min for 1 hour | | **Systemic corticosteroids** | Reduce airway inflammation; oral prednisolone 40–50 mg or IV methylprednisolone | | **Oxygen** | Maintain SpO₂ ≥90% (≥95% in pregnancy) | | **Ipratropium** | Add if poor initial response (anticholinergic + SABA synergy) | **Clinical Pearl:** Systemic corticosteroids take 4–6 hours to peak effect, so early administration is critical. Do NOT wait for response before giving them. **Mnemonic: SACS** — **S**ABA rapid; **A**dd systemic corticosteroids early; **C**heck response at 1 hour; **S**upport with oxygen. **Warning:** Simply increasing maintenance ICS/LABA dose (option A) does NOT provide rapid bronchodilation or sufficient systemic anti-inflammatory effect during acute exacerbation. Maintenance therapy escalation is for chronic control, not acute attacks. 
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