What is the management of acute asthma exacerbation?

From the Guidelines

Asthma exacerbation management should prioritize immediate treatment with oxygen, inhaled β2-agonists, and systemic corticosteroids, with the dose and frequency of administration dependent on the severity of the exacerbation. The most recent and highest quality study, 1, recommends that all clinicians treating asthmatic patients should be prepared to treat an asthma exacerbation, recognize the signs and symptoms of severe and life-threatening exacerbations, and be familiar with the risk factors for asthma-related death.

Key Management Strategies

• Administer oxygen to maintain saturation ≥93%
• Use inhaled β2-agonists, such as albuterol (salbutamol), via metered-dose inhaler with spacer or nebulizer
• Add systemic corticosteroids, such as prednisone 40-60 mg daily for 5-7 days, to reduce inflammation
• Consider ipratropium bromide (0.5 mg every 4-6 hours) for severe exacerbations
• Monitor patients closely and adjust treatment as needed to prevent deterioration

Patient Assessment and Triage

• Evaluate and triage patients immediately upon presentation
• Assess the severity of the exacerbation and institute treatment promptly
• Monitor patients frequently and adjust treatment as needed
• Consider special considerations in the assessment and treatment of infants experiencing asthma exacerbations, as they are at greater risk for respiratory failure 1

Discharge and Follow-up

• Patients can generally be discharged if FEV1 or PEF results are 70% or more of predicted value or personal best and symptoms are minimal or absent
• Prescribe 3 to 10 days of corticosteroid therapy to reduce the risk of recurrence
• Provide patients with a written asthma action plan, review inhaler technique, and schedule follow-up within 1-2 weeks 1

From the Research

Asthma Exacerbation Management Strategies

• Asthma exacerbations can be managed using a combination of medications, including short-acting β2-agonists (SABAs), inhaled corticosteroids (ICS), and long-acting beta2 agonists (LABAs) 2, 3, 4
• The use of a fixed-dose combination of albuterol and budesonide as rescue medication has been shown to reduce the risk of severe asthma exacerbation by 26% compared to albuterol alone 2
• In patients 12 years and older, home management of asthma exacerbations includes an inhaled corticosteroid/formoterol combination or a short-acting beta2 agonist, while in children 4-11 years of age, an inhaled corticosteroid/formoterol inhaler can be used to reduce the risk of exacerbations and need for oral corticosteroids 3
• Office-based management of asthma exacerbations involves assessing exacerbation severity, administering a short-acting beta2 agonist and oxygen, and considering oral corticosteroids and other treatments as needed 3

Medications Used in Asthma Exacerbation Management

• Salbutamol is a selective short-acting β2-agonist (SABA) used as an alternative reliever in the treatment of asthma, with its therapeutic effect based on its potent smooth muscle relaxant properties 5
• Inhaled corticosteroids (ICS) + fast-acting bronchodilator treatments can be used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations 6
• First-line treatment for asthma is inhaled salbutamol, used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger, or on a daily basis if necessary, in combination with an inhaled corticosteroid such as beclometasone 4

Best Practices for Asthma Exacerbation Prevention and Management

• Primary care clinicians play a key role in asthma and asthma exacerbation management, and evidence supports the use of inhaled corticosteroids (ICS) + fast-acting bronchodilator treatments to improve asthma control and reduce rates of exacerbations 6
• Incorporating patient perspectives and preferences when designing asthma regimens can help patients be more engaged in their therapy and may contribute to improved adherence and outcomes 6
• Identifying and avoiding factors that trigger or aggravate asthma attacks is an important step in managing asthma, and first-line treatment for asthma is inhaled salbutamol, used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger 4