Algorithm for the treatment of a severe attack of bronchial asthma at the stage of “ambulatory ambulance and hospital”

In the event that a severe attack is diagnosed, the child must be hospitalized by starting oxygen therapy, bronchospasmolytics through a nebulizer, glucocorticosteroids. In the absence of an intravenous nebulizer, aminophylline is administered. Upon admission to the hospital, the general principles of emergency treatment and monitoring its effect are the same as those at the ambulatory-ambulance stage.

Particular attention should be paid to children with risk factors for adverse outcomes. These include:  

1 severe course of the disease with frequent relapses        

2 steroid-dependent asthma        

3 history of repeated asthmatic status, especially during the last year        

4 more than 2 requests for medical care in the last day or more than 3 within 48 hours        

5 adolescents with panic and fear of death during an attack        

6 combination of bronchial asthma with epilepsy, diabetes        

7 low social, cultural, economic level of the family        

8 non-compliance with medical recommendations and appointments by parents and patients.        

1. In a severe attack , one of the following options for broncho-antispasmodic therapy is used: 

• Nebulizer therapy is preferred. Beta-2 agonists are used periodically at intervals of 20 minutes for an hour, then every 1-4 hours, as needed, or prolonged nebulization is performed (Appendix 2). The bronchospasmolytic effect can be enhanced by the addition of ipratropium bromide or by using a combination drug. beta-2 agonist and ipratropium bromide.


• In the absence of a nebulizer and no signs of an overdose of beta-2 agonists, 2-3 inhalations of a dosing aerosol of a beta-2 agonist through a spacer every 20 minutes for an hour, then every 1 -4 hours as necessary  


• If the patient cannot create a peak in the flow on exhalation, adrenaline of 0.01 ml / kg / dose or 1: 1000 (1 mg / ml) (maximum dose up to 0.3 ml) is administered.

2. Systemic glucocorticosteroids are administered parenterally or orally at the same time as 2 mg / kg / dose bronchospasmolytics. Untimely administration of glucocorticosteroids increases the risk of an adverse outcome. Repeated administration of glucocorticosteroids with insufficient effect after 6 hours.

3 Oxygen therapy through a mask or nasal catheter.

4 Eufillin IV can be an alternative therapy in the absence of inhalation equipment (a nebulizer and a metered-dose inhaler are not available) or administered with insufficient effect from inhalation methods. Eufillin 2.4% is injected iv slowly in a stream for 20-30 minutes, then, if necessary, intravenously drip for 6-8 hours.

A severe attack is an indication for hospitalization in a hospital or intensive care unit. The principles of treatment for a severe seizure that developed in a hospital are the same as in the outpatient phase.

event_note May 27, 2020

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