Asthma.

1. Asthma is defined as variable wheezy breathlessness. Cough rather than wheezing may be a presenting symptom, especially in children. Many asthmatics have predominantly nocturnal symptoms. 2. A severe attack is suggested by any of the following factors: a respiratory rate of > 25 breaths/minute, a tachycardia of > 110 beats/minute, a reduction by more than 40% in the normal peak expiratory flow rate (PEFR) or less than 200 l/min if usual PEFR not known), an inspiratory fall in arterial blood pressure of 10 mmHg. 3. The initial treatment of an acute attack includes nebulized beta 2 agonist bronchodilators. A pressurized aerosol given by a Volumatic or Nebuhaler device may also be effective. A short course of steroids should be initiated promptly starting with 30-60 mg of oral prednisolone as a single dose. Intravenous aminophylline should not be given to patients taking oral theophylline or aminophylline. 4. Signs of an imminent threat to life include: a silent chest on auscultation, cyanosis, bradycardia, exhaustion, confusion, or unconsciousness. 5. Indications for urgent referral to hospital include a PEFR < 40% of normal (or less than 200 l/minute for adults) 15-30 minutes after nebulized salbutamol, any life-threatening features and if any other features of a severe attack persist after initial treatment. The threshold for admission will also be affected by the social circumstances. 6. The first line treatment of chronic asthma is inhaled beta 2 agonists. Correct inhaler techniques should be reinforced on several occasions.(ABSTRACT TRUNCATED AT 250 WORDS)