Acute Severe Asthma

• Monitor PEF, which should increase to greater than 70% of personal best or predicted after the first three doses of an inhaled SABA.

• Monitor patients for hypoxemia. Oxygen saturation should be greater than 90% in adults and greater than 95% in children, pregnant women, and patients with coexisting cardiovascular disease.

• In patients with severe exacerbations, monitoring of Pco2 should be considered. Patients with acute asthma usually have a respiratory alkalosis, and a normal or increased Pco2 indicates the potential for respiratory failure.

• Monitor serum potassium in patients receiving high-dose or continuous nebuliza-tion of SABA. Serum potassium concentrations should be obtained upon hospital admission, and if the patient is hypokalemic, every 4 hours (after each 30 to 40 mEq [mmol] of replacement) until the serum potassium is stable. Serum potassium should be monitored every 3 to 6 months after discharge.

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