What criteria should I use to decide whether to refer a patient with an acute asthma exacerbation to secondary care?

Refer a patient with an acute asthma exacerbation to secondary care if there are signs of a life-threatening exacerbation, such as cyanosis, drowsiness, exhaustion, poor respiratory effort, confusion, oxygen saturation less than 92%, hypotension, PEF less than 33% of best or predicted, or a silent chest ¹.

Arrange hospital admission if there are signs of an acute severe exacerbation that do not respond to initial treatment, including inability to complete sentences, oxygen saturation below 92%, respiratory rate over 25 breaths per minute, pulse over 110 beats per minute, or PEF between 33-50% ¹.

Consider urgent transfer to hospital if symptoms worsen despite initial treatment or if the patient exhibits signs of a moderate exacerbation with inadequate response, such as poor response to inhaled bronchodilators, or if the patient is unable to manage at home safely ¹.