From the Guidelines
Management of asthma exacerbation requires prompt assessment and stepwise treatment, with the most recent and highest quality study 1 guiding the approach to prioritize morbidity, mortality, and quality of life. The management of asthma exacerbation involves several key components, including:
- Immediate treatment with inhaled short-acting beta-agonists (SABAs) like albuterol, oxygen therapy to maintain saturation ≥93%, and systemic corticosteroids such as prednisone 40-60 mg daily for 5-7 days for most adults 1.
- For severe exacerbations, consider adding ipratropium bromide 0.5 mg by nebulizer every 20 minutes for the first hour, then every 2-4 hours, and intravenous corticosteroids (methylprednisolone 60-125 mg) 1.
- Monitoring response through clinical assessment, peak flow measurements, and oxygen saturation is crucial, with the goal of achieving FEV1 or PEF results of 70% or more of predicted value or personal best and minimal or absent symptoms before discharge 1.
- The use of systemic corticosteroids, such as methylprednisolone 125 mg, is recommended for acute asthma exacerbations, as they have been shown to hasten the resolution of airflow obstruction and reduce hospital admissions 1. Key considerations in the management of asthma exacerbation include:
- Prompt assessment and treatment to prevent deterioration and reduce the risk of asthma-related death 1.
- Familiarity with the risk factors for asthma-related death and special considerations in the assessment and treatment of infants experiencing asthma exacerbations 1.
- The importance of providing an asthma action plan and arranging follow-up within 1-2 weeks after stabilization to review and adjust the patient's maintenance therapy 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 During this time most patients gain optimum benefit from regular use of the inhalation solution. If a previously effective dosage regimen fails to provide the usual relief, medical advice should be sought immediately, as this is often a sign of seriously worsening asthma that would require reassessment of therapy.
The management of asthma exacerbation with albuterol (INH) involves administering the usual dosage of 2.5 mg three to four times daily by nebulization, as needed to control recurring bouts of bronchospasm.
- Key points:
- Administer 2.5 mg of albuterol three to four times daily by nebulization.
- Continue use as medically indicated to control recurring bouts of bronchospasm.
- Seek medical advice immediately if a previously effective dosage regimen fails to provide the usual relief, as this may indicate worsening asthma 2.
From the Research
Management of Asthma Exacerbation
- Asthma exacerbations are defined as a deterioration in baseline symptoms or lung function, causing significant morbidity and mortality 3
- Management strategies for asthma exacerbations include the use of asthma action plans, inhaled corticosteroids, and short-acting beta2 agonists
Home Management
- For patients 12 years and older, home management includes an inhaled corticosteroid/formoterol combination or a short-acting beta2 agonist 3
- In children four to 11 years of age, an inhaled corticosteroid/formoterol inhaler can be used to reduce the risk of exacerbations and need for oral corticosteroids 3
Office Setting Management
- In the office setting, it is essential to assess exacerbation severity and begin treatment with a short-acting beta2 agonist and oxygen 3
- Patients with severe exacerbations should be transferred to an acute care facility and treated with oxygen, frequent administration of a short-acting beta2 agonist, and corticosteroids 3
Treatment Options
- The addition of a short-acting muscarinic antagonist and magnesium sulfate infusion has been associated with fewer hospitalizations 3
- Inhaled corticosteroids, long-acting beta2 agonists, and biological agents can be used as controller medications for persistent asthma 4
- Metered-dose inhalers with a spacer and nebulization are effective delivery methods for albuterol in acute asthma exacerbations 5, 6, 7
Treatment Frequency
- Albuterol metered-dose inhaler with a holding chamber can be given optimally at 60-min intervals with minimal adverse effects for the majority of patients 6
- However, patients who initially demonstrate a low or poor bronchodilator response to albuterol should be given subsequent treatments at 30-min intervals 6