Last reviewed
2026-02-07
Workflow pack
Wheeze/asthma exacerbation workflow
Primary care wheeze workflow for rapid severity framing, escalation triggers, and controller-plan reinforcement.
Trust and governance
Use only within this workflow's defined scope and exclusions.
Clinical owner
Family Medicine Editorial Team
Risk tier
High
Review cadence
Every 3 months
Next due 2026-05-07
Review status
Current
Scope limits
Outpatient initial management of wheeze/asthma symptoms in patients without immediate respiratory failure signs.
Exclusions (escalate/redirect)
- Severe respiratory distress, hypoxia, or exhaustion requiring emergency pathway.
- Inpatient-level acute asthma management.
References
Escalate-now emphasis (high-risk workflow)
If any red-flag item is present, stop routine workflow steps and activate emergency escalation immediately.
At a glance
Rapid decision framing for in-visit use. Educational only; always apply clinical judgment.
Immediate actions
- Assess breathing effort, oxygenation, and speech tolerance immediately.
- Confirm reliever use response and current exacerbation trajectory.
- Identify high-risk comorbidity or prior severe exacerbation history.
Red flags / escalate now
- Hypoxia, silent chest, exhaustion, or altered level of consciousness.
- Poor response to initial reliever pathway with persistent respiratory distress.
- Any rapid deterioration in airway/breathing status.
First-line plan
- Start rapid reliever management and repeat objective reassessment.
- Address inhaler technique and adherence barriers in-visit.
- Define controller-plan and escalation boundaries before discharge.
Follow-up and monitoring
- Arrange short-interval reassessment after acute symptom visit.
- Escalate to urgent/emergency care for incomplete response or relapse.
- Reinforce action plan and return precautions in plain language.
Condition guidance
Prescribing aids
Referral checklists
Tools and calculators
Patient handouts
Return precautions (patient script)
Suggested plain-language wording for safety-net counseling:
If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.
- Use with the specific red flags listed on this page.
- Confirm follow-up timing and where to go after-hours.
- Document that return precautions were reviewed and understood.
Visit-close checklist
- Document disposition, rationale, and unresolved diagnostic uncertainty.
- Give explicit return precautions and follow-up timeline before ending visit.
- Attach a relevant handout when available to reinforce adherence and safety-netting.