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In their excellent article on asthma exacerbations,1 Aldington Beasley, ask “…why there is such a huge discrepancy between the management of severe asthma recommended by evidence based guidelines, and that observed in clinical practice”.
Although the guidelines are in fact quite simple and straightforward, I think that non-specialist junior physicians in the emergency department are confused by the apparent complexity of, for example, fig 3 from their article reproduced from the British Thoracic Society guidelines, especially when faced with an extremely unwell patient with asthma.
For a number of years, I have taught a very simple “6 P rule” for the assessment of asthma:
PEFR—baseline and response to first nebuliser.
Pulse, >120 (it is not due to salbutamol).
pO2 (measure and then titrate oxygen against O2 saturation).
Panic (ie, ability to speak/respiratory rate).
Paradox (patients cannot sustain this for long).
Pneumothorax (make sure the trachea is central until you can obtain a chest x ray; and do not allow anyone to put in a subclavian line).
This is the basic information needed to assess severity, and decide on management, and it is more easily taught and remembered than a complex figure.
Competing interests: None.
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