What is the treatment for an asthma exacerbation?

From the Guidelines

The treatment for an asthma exacerbation involves prompt administration of short-acting beta-agonists (SABAs) like albuterol (salbutamol) via a metered-dose inhaler with spacer or nebulizer, typically 2-4 puffs every 20 minutes for the first hour or 2.5-5 mg via nebulizer, as recommended by the National Asthma Education and Prevention Program Expert Panel report 3 guidelines for the management of asthma exacerbations 1.

Key Components of Treatment

• Systemic corticosteroids should be given early, such as prednisone 40-60 mg orally daily for 5-7 days for adults or prednisolone 1-2 mg/kg/day (maximum 60 mg) for children, to reduce inflammation and hasten the resolution of airflow obstruction 1.
• Oxygen therapy should be provided to maintain oxygen saturation above 92% to prevent hypoxia and its complications.
• For moderate to severe exacerbations, ipratropium bromide can be added to the nebulizer treatment (0.5 mg every 4-6 hours) to provide additional bronchodilation.
• In severe cases not responding to initial therapy, intravenous magnesium sulfate (2 g over 20 minutes) may be considered, as it has been shown to reduce the risk of hospital admission and improve lung function 1.

Monitoring and Follow-Up

• Continuous monitoring of symptoms, oxygen saturation, and lung function is essential to assess the response to treatment and adjust the therapy as needed.
• 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, with a prescription for 3 to 10 days of corticosteroid therapy to reduce the risk of recurrence 1.

Special Considerations

• Infants are at greater risk for respiratory failure, and clinicians should be familiar with special considerations in the assessment and treatment of infants experiencing asthma exacerbations 1.
• Consultation with or comanagement by a physician expert in ventilator management is essential for patients requiring mechanical ventilation, as ventilation of patients with severe asthma is complicated and risky 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 treatment for an asthma exacerbation is albuterol inhalation solution administered by nebulization. The usual dosage is 2.5 mg for adults and children weighing at least 15 kg, given three to four times daily 2.

• Key points:
  • Dosage: 2.5 mg
  • Administration: Nebulization
  • Frequency: Three to four times daily
  • Patient population: Adults and children weighing at least 15 kg It is essential to follow the recommended dosage and administration guidelines to ensure effective treatment and minimize potential side effects 2.

From the Research

Treatment for Asthma Exacerbation

The treatment for asthma exacerbation typically involves a combination of medications and therapies to manage symptoms and reduce airway inflammation. Some key treatment options include:

• Short-acting β2 agonists and short-acting muscarinic antagonists as bronchodilators to relieve acute symptoms 3
• Systemic corticosteroids to reduce airway inflammation, with the oral route being the preferred method unless contraindicated 3
• Intravenous magnesium sulfate in selected cases, particularly in severe exacerbations 3, 4, 5
• Helium-oxygen mixtures for patients who do not respond to standard therapies or those with severe disease 3
• Inhaled corticosteroids and long-acting β2 agonists for maintenance therapy in patients with persistent asthma 6, 7

Management Strategies

Asthma exacerbations can be managed using various strategies, including:

• Asthma action plans to help patients triage and manage symptoms at home 7
• Home management with inhaled corticosteroid/formoterol combination or short-acting beta2 agonist 7
• Office-based management with short-acting beta2 agonist, oxygen, and oral corticosteroids 7
• Acute care facility treatment with oxygen, frequent administration of short-acting beta2 agonist, and corticosteroids for severe exacerbations 7

Role of Magnesium Sulfate

Intravenous magnesium sulfate has been shown to reduce hospital admissions and improve lung function in adults with acute asthma who have not responded sufficiently to first-line treatment 5. However, the effectiveness of this approach may vary depending on the severity of the exacerbation and the use of co-medications 5. Inhaled magnesium sulfate may also be useful in improving lung function and reducing hospital admissions in severe asthma crisis 4.