Severe Asthma Exacerbation / Status Asthmaticus
Source: GINA (Global Initiative for Asthma) 2025 · Last reviewed: Jul 2026
1
Initial Action
Assess severity. Oxygen as needed, target SpO₂ ≥94%.
2
First-line (first hour)
- High-dose SABA, repeat every 20 min
- Systemic corticosteroid as early as possible
- Ipratropium bromide combined with SABA if severe
3
Decision
Inadequate response / life-threatening exacerbation?
Yes → IV magnesium sulfate (not nebulised — no longer recommended by GINA 2025).
Life-threatening Signs
Reduced consciousnessSilent chestCyanosisRespiratory muscle fatigue
Prepare for possible intubation — high risk (barotrauma, post-intubation hypotension from air-trapping).
Educational quick reference only, not a substitute for clinical judgement. Full dose details are in the Drug & Fluid menu.