What medication can be given to a 92-year-old patient with an asthma exacerbation to calm them down during a computed tomography (CT) scan?

From the Guidelines

For a 92-year-old patient experiencing an asthma exacerbation who needs to remain calm during a CT scan, a short-acting benzodiazepine like lorazepam (Ativan) 0.5-1 mg orally or intravenously would be appropriate, in conjunction with inhaled bronchodilators such as albuterol 2.5-5 mg every 20 minutes for 3 doses, then as needed, as recommended by the National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations 1. This approach is based on the need to manage both the anxiety and the asthma exacerbation. The dose of lorazepam should be on the lower end of the range due to the patient's advanced age, as elderly patients are more sensitive to benzodiazepines. Administration of lorazepam should occur about 30-45 minutes before the scan if given orally, or 5-10 minutes before if given intravenously. It's essential to monitor the patient's vital signs, including oxygen saturation, during and after the procedure. Benzodiazepines work by enhancing the effect of the neurotransmitter GABA, producing a calming effect without directly worsening asthma symptoms. However, the patient should also receive appropriate asthma medications to manage the exacerbation itself, as anxiety reduction alone won't address the underlying airway inflammation and bronchoconstriction. The use of systemic corticosteroids, such as methylprednisolone, may also be considered to reduce inflammation, as suggested by the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Additionally, inhaled ipratropium bromide may be added to the treatment regimen for severe exacerbations, as indicated by the guidelines for the management of asthma exacerbations 1. For older adults, it's crucial to consider coexisting medical conditions and adjust medications accordingly, as recommended by the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1.

From the FDA Drug Label

WARNINGS As with other inhaled beta-adrenergic agonists, albuterol sulfate inhalation solution can produce paradoxical bronchospasm, which can be life threatening. Note: Use only as directed by your physician. More frequent administration or higher doses are not recommended.

The medication that can be given to a 92-year-old patient with an asthma exacerbation to calm them down during a CT scan is albuterol. However, it is essential to use it only as directed by a physician, and more frequent administration or higher doses are not recommended. It is crucial to monitor the patient for any signs of paradoxical bronchospasm, which can be life-threatening 2.

From the Research

Medication Options for Asthma Exacerbation in a 92-year-old Patient

To calm down a 92-year-old patient with an asthma exacerbation during a computed tomography (CT) scan, the following medication options can be considered:

• Short-acting beta-agonists, such as albuterol, which provide rapid relief of acute symptoms 3, 4, 5
• Inhaled corticosteroids, which are the standard of care for persistent asthma 3, 6
• Combination therapy, including inhaled corticosteroids and long-acting beta-agonists, for patients whose asthma is not well controlled on moderate doses of inhaled corticosteroid 3, 6
• Ipratropium bromide, a quaternary anticholinergic bronchodilator, which can be used as adjunctive therapy for the emergency treatment of acute asthma exacerbation 7

Considerations for Medication Administration

When administering medication to a 92-year-old patient with an asthma exacerbation, the following considerations should be taken into account:

• The patient's medical history and current medications should be reviewed to ensure safe and effective treatment 4, 6
• The patient's oxygen saturation levels should be monitored and maintained during the CT scan 4
• The patient's response to medication should be closely monitored, and adjustments made as needed 3, 5

Additional Therapies

Additional therapies that may be considered for a 92-year-old patient with an asthma exacerbation include:

• Oxygen therapy to maintain oxygen saturation levels 4
• Magnesium sulfate infusion, which has been associated with fewer hospitalizations 4
• Systemic corticosteroids, which may be necessary for severe exacerbations 4, 6