Clinical management of Asthma in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
No fever. Difficulty in breathing (recurrent attacks) with chest tightness. Wheezing, rhonchi. Cough - dry, intermittent, worse at night.
Investigations
Peak flow rate (increases >200ml post-bronchodilator). Spirometry (increase in FEV1 >12%).
Emergency Management
Acute Mild to Moderate Attack
Salbutamol inhaler 2-10 puffs via spacer OR 5 mg (2.5 mg in children) nebulisation. Repeat every 20-30 min if necessary. Prednisolone 50 mg (1 mg/kg for children).
Discharge after Mild/Moderate
Prednisolone 50 mg (1 mg/kg for children) once a day for 5 days (3 days for children). Review in 48 hours.
Acute Severe Attack
High flow oxygen (aim SpO2 ≥94%). Salbutamol 2-10 puffs or 5mg nebulisation repeated every 20-30 min during 1st hour. Prednisolone 50 mg OR Hydrocortisone 100 mg IV every 6 hours.
Acute Severe Attack (Poor response)
Ipratropium bromide nebuliser 500 mcg every 20-30 min for 2 hours. OR Aminophylline 250 mg slow IV bolus.
Life Threatening Attack
Immediate hospital admission. Oxygen. Salbutamol repeat every 20 min for 1 hour. Hydrocortisone 100 mg IV stat. Ipratropium nebuliser. If poor response, Aminophylline 250 mg IV bolus.
Treatment
Chronic Step 1: Intermittent
Inhaled short-acting beta2 agonist (salbutamol 1-2 puffs prn).
Chronic Step 2: Mild Persistent
Salbutamol inhaler 1-2 puffs prn PLUS regular standard-dose inhaled corticosteroid (e.g. beclomethasone 100-400 mcg every 12 hours).
Chronic Step 3: Moderate Persistent
Salbutamol inhaler prn PLUS high-dose inhaled corticosteroids (beclomethasone 400-1000 mcg every 12 hours). Consider 6-week trial of Aminophylline 200 mg every 12 hours.
Chronic Step 4: Severe Persistent
Refer to specialist. Regular high-dose beclomethasone PLUS regular oral prednisolone 10-20 mg daily.
Clinical Tools