Acute exacerbation
acute asthma
- oxygen only if SpO₂ < 92%, target 92–95% (GINA 2026)
- salbutamol 2.5–5 mg neb every 20 min for the first hour, then by response
- moderate or severe → add ipratropium 500 mcg with each of the first three salbutamol doses
- steroid within 1 h → prednisolone 1 mg/kg PO OD, max 50 mg, 5–7 days; cannot swallow → methylprednisolone 40 mg IV: steroids
- not responding at 1 h, or life-threatening → magnesium sulfate 2 g IV over 20 min, ICU
- full approach → dyspnea
acute COPD exacerbation
- oxygen target 88–92% if at risk of hypercapnic respiratory failure (GOLD)
- salbutamol 2.5–5 mg + ipratropium 500 mcg neb, repeat salbutamol by response
- prednisolone 40 mg PO OD for 5 days, no taper: steroids
- antibiotic if purulent sputum with more dyspnea or volume, or needing NIV → empiric antibiotics
- NIV early if arterial pH ≤ 7.35 with PaCO₂ > 45 mmHg (ABG, not VBG)
- full approach → dyspnea
Nebulizers & inhalers
| Generic | Brand | Route | Dose | Notes |
|---|---|---|---|---|
| Salbutamol | Ventolin | neb / MDI | 2.5–5 mg neb PRN | SABA |
| Ipratropium | Atrovent | neb / MDI | 250–500 mcg neb QDS | SAMA |
| Budesonide | Pulmicort | neb | per local protocol | ICS neb; not standard for acute COPD exacerbation |
| Budesonide / formoterol | Symbicort | MDI | maintenance | ICS / LABA |
| Fluticasone / salmeterol | Seretide | MDI | maintenance | ICS / LABA |
| Fluticasone / umeclidinium / vilanterol | Trelegy Ellipta | DPI | 92/55/22 mcg, 1 inhalation OD | Triple ICS / LAMA / LABA |
Mucolytics & airway adjuncts
| Generic | Brand | Route | Dose | Notes |
|---|---|---|---|---|
| Acetylcysteine (oral) | NAC, Fluimucil | PO | 600 mg OD–BD (effervescent) | Mucolytic |
| Acetylcysteine (nebulized) | NAC | neb | 3–5 mL of 20% solution, BD–QDS | Mucolytic; give with/after SABA (bronchospasm risk) |
| Hypertonic saline | – | neb | 3% (or 7%) 4 mL BD | Mucoactive; pre-treat with SABA; watch for bronchospasm |
Paracetamol overdose → IV acetylcysteine is a separate protocol: liver function.
Educational reference for clinicians. Doses are typical adult starting points. Cross-check allergies, interactions, current local policy, the formulary, and renal/hepatic function before prescribing.
Last updated · October 2026