From the Guidelines
Treatment for Mild Acute Asthma Exacerbation
Mild acute asthma exacerbation should be treated with high doses of a short-acting beta-2 agonist (SABA), such as albuterol, administered through a metered-dose inhaler (MDI) with a valved holding chamber or by nebulizer therapy 1.
- The recommended dose is 4-12 puffs of a SABA administered by trained personnel through an MDI with a valved holding chamber or by means of nebulizer therapy 1.
- Treatment should be administered every 20 to 30 minutes for initial therapy, with the frequency of treatment varying according to patient response 1.
- For patients with mild exacerbations, nebulizer therapy might be preferred for those who are unable to cooperate effectively in using an MDI due to their age, agitation, or more severe exacerbations 1.
- It is also crucial to monitor the patient's peak expiratory flow (PEF) and symptoms to assess the response to treatment and adjust the plan accordingly 1.
- If symptoms persist, consider adding an oral corticosteroid such as prednisone at a dose of 40 to 50 milligrams per day for 3 to 5 days to reduce inflammation 1.
- Ensure the patient's asthma action plan is updated and followed, and consider adjusting their long-term control medications as needed 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm
The treatment for a mild acute asthma exacerbation is albuterol inhalation solution administered by nebulization. The recommended dosage is 2.5 mg administered three to four times daily for adults and children weighing at least 15 kg 2.
From the Research
Treatment for Mild Acute Asthma Exacerbation
The treatment for mild acute asthma exacerbation involves the use of various medications to relieve symptoms and prevent further exacerbations.
- According to 3, the Global Initiative for Asthma (GINA) 2019/2020 recommends an anti-inflammatory rescue/reliever approach for adult and adolescent patients, based on the combination of an inhaled corticosteroid with a rapid onset β2-agonist such as formoterol.
- Short-acting beta-agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy due to significant safety concerns and poor outcomes 4.
- Regular use of inhaled corticosteroids (ICS) is recommended for preventing exacerbations and improving forced expiratory volume in 1 s (FEV1) in children and adolescents/adults with mild asthma 5.
- High-dose, frequent or continuous nebulized short-acting beta2 agonist (SABA) therapy can be combined with a short-acting muscarinic antagonist (SAMA) for the treatment of acute exacerbation of asthma (AEA) 6.
- The use of oral or parenteral corticosteroids should be considered when patients do not rapidly respond to SABA/SAMA inhalation, and adjunctive therapies such as intravenous magnesium and helium/oxygen combination gas for inhalation may also be considered 6.
- Long-acting beta-agonists (LABAs) can provide more prolonged bronchodilation and reduce the need for short-acting beta-agonists, but should be used in combination with inhaled corticosteroids 7.