What are the recommended steps for the immediate management of a patient experiencing an acute asthma exacerbation in primary care?

Assess the severity of the exacerbation by taking a detailed history and performing a physical examination, including checking for signs of life-threatening features such as cyanosis, drowsiness, or exhaustion, and measuring oxygen saturation if possible ¹.

Administer controlled oxygen to adults and high-flow oxygen to children, aiming for an oxygen saturation of 94–98%, without delaying treatment if pulse oximetry is unavailable ¹.

Give nebulised salbutamol (5 mg if over 5 years, 2.5 mg if 2–5 years) preferably via oxygen-driven nebuliser, and nebulised ipratropium bromide (0.5 mg for adults, 0.25 mg for children 2–12 years) in life-threatening cases ¹.

Repeat doses of nebulised bronchodilator every 20–30 minutes if there is an inadequate response to initial treatment ¹.

For patients unable to use nebulisers, give salbutamol (100 micrograms) by pMDI and spacer, one puff every 60 seconds, up to 10 puffs, inhaled separately using tidal breathing ¹.

Start systemic corticosteroids immediately, with oral prednisolone (40–50 mg for adults and children 16+; 30–40 mg for 6–15 years; 20 mg for 2–5 years; 10 mg for under 2 years). If oral administration is not possible, give IM methylprednisolone or IV hydrocortisone as appropriate ¹.

Arrange urgent transfer to hospital if signs of life-threatening exacerbation are present or if symptoms do not respond to initial treatment ¹.