Asthma exacerbation

Template

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Lung examChoose one

Work of breathing presentChoose any

Work of breathing absentChoose any

Oxygen saturationChoose one

Clinic treatmentChoose one

OxygenChoose any

TestingChoose any

SteroidChoose one

ControllerChoose one

PlanChoose one

Asthma careChoose any

Asthma care additionsChoose any

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling

Use Albuterol with the spacer as needed for cough, wheeze, or trouble breathing, following the asthma action plan. Recommended supportive care with an emphasis on hydration, rest, and avoiding smoke, vape, and known triggers. Go to the emergency department for trouble breathing, pulling in at the ribs or neck, trouble speaking, lips turning blue, or Albuterol not helping. Return precautions given including needing Albuterol more often than the action plan allows, fever, not drinking well, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Use the SMART inhaler every day as the controller, and take extra puffs as needed for cough, wheeze, or trouble breathing, following the asthma action plan. Recommended supportive care with an emphasis on hydration, rest, and avoiding smoke, vape, and known triggers. Go to the emergency department for trouble breathing, pulling in at the ribs or neck, trouble speaking, lips turning blue, or the inhaler not helping. Return precautions given including needing extra puffs more than the plan allows, fever, not drinking well, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Asthma exacerbation
• Expiratory wheeze with good air movement
• No retractions, nasal flaring, or grunting
• Oxygen saturation 95% or higher on room air
• Albuterol given in clinic with improvement in wheeze and work of breathing
• Decadron given in clinic
• Home with Albuterol and spacer as needed
• Inhaler and spacer technique reviewed
• Asthma action plan reviewed and updated
• Follow up in 2-3 days to recheck breathing

Use Albuterol with the spacer as needed for cough, wheeze, or trouble breathing, following the asthma action plan. Recommended supportive care with an emphasis on hydration, rest, and avoiding smoke, vape, and known triggers. Go to the emergency department for trouble breathing, pulling in at the ribs or neck, trouble speaking, lips turning blue, or Albuterol not helping. Return precautions given including needing Albuterol more often than the action plan allows, fever, not drinking well, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Work of breathing
Oxygen saturation (> 90% target in severe)
Chest x-ray result
Dexamethasone early (as effective as methylprednisolone)
Daily ICS; SMART older than 5 for step 3-4; intermittent ICS 0-4
Technique, action plan, triggers
Follow-up after exacerbation

Return precautions in the template

needing Albuterol more often than the action plan allowsfevernot drinking well

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.