A fictional 30-year-old with asthma is unable to finish sentences, is using accessory muscles and has deteriorated despite repeated reliever use.
Frame the danger first.
- Assess speech, respiratory rate, pulse, oxygenation, peak flow when feasible and signs of exhaustion.
- A quiet chest, altered consciousness or worsening gas exchange can indicate life-threatening disease.
- Consider anaphylaxis, pneumothorax, pulmonary embolism and upper-airway obstruction when the picture is atypical.
Act, escalate, reassess.
- Call for senior help and use the current local acute-asthma pathway with continuous reassessment.
- Provide protocol-directed oxygen and bronchodilator treatment promptly, adding systemic therapy as locally directed.
- Measure objective response where safe and arrange investigations without delaying treatment.
- Escalate early to critical care if life-threatening features, fatigue or inadequate response develop.
Red flags that change pace.
- Silent chest, cyanosis, poor respiratory effort, altered consciousness or exhaustion
- Hypotension, arrhythmia, worsening hypoxaemia or concerning blood-gas change
- Failure to improve promptly or previous near-fatal asthma
What makes care less safe.
- Being reassured by less wheeze when airflow is worsening
- Delaying treatment to obtain peak flow or imaging
- Failing to document response and prepare an escalation plan
Say the concern plainly.
Acute asthma with severity features [list], baseline/current peak flow if available [result], oxygenation [result] and response to treatment [summary]. I need urgent respiratory/critical-care review because of [red flag or non-response].