Asthma - Management of Exacerbations

Routine prescribing of antibiotics for asthma exacerbations is not warranted as most are viral or non-infective.

Consider antibiotics if systemic symptoms are present; follow local antimicrobial guidelines.

Green sputum alone is not diagnostic of bacterial infection and occurs due to inflammation.

Prescribe prednisolone 40-50mg daily for 7-14 days then stop, and advise patient to return if not better.

Only reduce prednisolone dose slowly if patient:

• has received repeated courses (especially if taken for longer than 3 weeks)
• has other factors pre-disposing to adrenal suppression (e.g. Addison’s disease)

Children’s dosing of prenisolone

  • 1 month to 11 years: 1-2 mg/kg once daily for up to 3 days (max dose 40mg)
  • 12 years to 17 years: 40-50mg daily for at least 5 days

– see BNF for Children for further information.

Rescue packs

Prescribe only on advice of respiratory consultant:

Prednisolone - 5mg tablets, supply 56
Dose - eight tablets daily for seven days

Antibiotics are rarely necessary - follow respiratory specialist advice.  Follow local antimicrobial guidelines.

  • Ensure patient is clear when and how to use
  • Include in written self-management plan
  • Advice to notify GP practice when treatment started
  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs with Shared Care Guidelines
  • Specialist Only Drugs
  • Mixed Status