Bronchospasm (Wheezing)
Treatment of acute shortness of breath due to asthma, COPD, or anaphylaxis
Indications
- History of allergy, asthma, COPD, or anaphylaxis
- Relief of acute shortness of breath
- Clinical presentation consistent with reactive airways
- First presentation in high dust/allergen environment
Contraindications for Salbutamol/Ventolin
| Condition | Type |
|---|---|
| Allergy to salbutamol/Ventolin | Absolute |
| Symptomatic tachycardia (HR >150 bpm) | Relative |
Cautions
- Heart disease with active chest pain (salbutamol increases oxygen demand)
- Fever present: Avoid nebulized medication to reduce infectious disease spread
Treatment by Scope
SFA, FR, EMR, and up
- Call dispatch for assistance, backup, or 911
- Obtain baseline vitals including O2 saturation (when possible)
- Consider oxygen therapy
PCP, RPN, LPN, RN, ACP
- As above, plus perform history and primary/secondary survey
- Ask: "Have you ever been admitted to ICU with respiratory failure?"
- If YES: High suspicion patient could deteriorate rapidly
- Give: 4-8 puffs of 100 mcg/inhalation OR 5 mg salbutamol via nebulizer
- Repeat: Every 5-10 minutes as needed
- Monitor closely with serial vitals and oximetry
- Discontinue if signs of toxicity (HR >150 bpm, severe tremor)
- If no improvement after 3 treatments, consider transfer to higher care
Quick Dosing Reference
| Method | Dose |
|---|---|
| Inhaler (MDI) | 4-8 puffs (100 mcg each) |
| Nebulizer | 5 mg salbutamol |
| Frequency | Every 5-10 minutes as needed |
| Max Treatments | 3 before considering transfer |
Signs of Toxicity - STOP Treatment
- Heart rate above 150 bpm
- New and severe tremor
Additional Medications (with CDM order)
In mixed multi-disciplinary teams, patients may also receive:
- Ipratropium bromide (Atrovent)
- Inhaled steroids (Pulmicort, Flovent)
- Oral steroids (prednisone, dexamethasone)
Assisting with delivery of these medications when ordered by a responsible prescriber is acceptable.
⚠️ ICU History: If patient has history of ICU admission for respiratory failure, maintain high index of suspicion for rapid deterioration.
Transfer Considerations
For transfer to acute care, consider:
- Does patient need CPAP/BIPAP support?
- Intubation needed for transport?
- What medications for transfer?
- Should provider accompany patient?
⚠️ Infectious Disease: If patient may have infectious disease, avoid nebulized medication - use MDI instead.
Source: Odyssey Medical Consulting
Version: 2023-06-21