What is the treatment for an acute moderate persistent asthma flare?

From the Guidelines

The treatment for an acute moderate persistent asthma flare involves prompt administration of short-acting beta-agonists (SABAs) such as albuterol, typically 2-4 puffs via metered-dose inhaler with spacer every 20 minutes for the first hour, or a nebulizer treatment (2.5-5 mg albuterol) every 20 minutes for 1 hour, as recommended by the NAEPP guidelines 1. This should be followed by oral corticosteroids like prednisone at a dose of 40-60 mg daily for 5-7 days to reduce airway inflammation, as oral systemic corticosteroids are recommended for moderate to severe asthma exacerbations 1. Supplemental oxygen should be provided to maintain oxygen saturation above 90%. After initial treatment, the patient should continue albuterol every 3-4 hours as needed for 24-48 hours. If symptoms improve, the patient can transition back to their maintenance therapy, which typically includes an inhaled corticosteroid (ICS) combined with a long-acting beta-agonist (LABA), as long-acting beta2 agonists are used as an adjunct to inhaled corticosteroid therapy for providing long-term control of symptoms 1. Close monitoring is essential during the first few hours of treatment to assess response. These medications work together to relax bronchial smooth muscles, reduce inflammation, and improve airflow. If symptoms worsen or fail to improve after initial treatment, the patient should be evaluated for possible hospitalization as this may indicate progression to severe asthma. It is also important to note that increasing the use of short-acting beta2 agonists or using them more than two days per week for symptom relief generally indicates inadequate control of asthma and the need to initiate or intensify anti-inflammatory therapy 1.

Some key points to consider in the treatment of acute moderate persistent asthma flare include:

• The importance of prompt administration of short-acting beta-agonists and oral corticosteroids
• The need for supplemental oxygen to maintain oxygen saturation above 90%
• The role of inhaled corticosteroids and long-acting beta-agonists in maintenance therapy
• The importance of close monitoring during the first few hours of treatment to assess response
• The need to evaluate the patient for possible hospitalization if symptoms worsen or fail to improve after initial treatment.

In terms of the evidence, the NAEPP guidelines provide strong recommendations for the treatment of acute moderate persistent asthma flare, including the use of short-acting beta-agonists, oral corticosteroids, and inhaled corticosteroids combined with long-acting beta-agonists 1. The guidelines also emphasize the importance of close monitoring and the need to evaluate the patient for possible hospitalization if symptoms worsen or fail to improve after initial treatment. Overall, the treatment of acute moderate persistent asthma flare requires a comprehensive approach that includes prompt administration of medications, close monitoring, and evaluation for possible hospitalization.

From the Research

Treatment for Acute Moderate Persistent Asthma Flare

• The treatment for an acute moderate persistent asthma flare typically involves a combination of medications, including inhaled corticosteroids and long-acting beta2-agonists (LABAs) 2, 3.
• According to the Global Initiative for Asthma (GINA) guidelines, patients with moderate persistent asthma should receive a combination of inhaled corticosteroids and LABAs for maintenance and relief 4.
• For patients 12 years and older, home management of asthma exacerbations includes an inhaled corticosteroid/formoterol combination for those not using an inhaled corticosteroid/LABA inhaler for maintenance, or a short-acting beta2 agonist for those using an inhaled corticosteroid/LABA inhaler that does not include formoterol 5.
• In the office setting, treatment for an acute moderate persistent asthma flare should include assessment of exacerbation severity, short-acting beta2 agonist and oxygen to maintain oxygen saturations, and oral corticosteroids 5.
• The addition of a short-acting muscarinic antagonist and magnesium sulfate infusion has been associated with fewer hospitalizations in patients with severe exacerbations 5.

Medication Options

• Salmeterol/fluticasone propionate is a combination of a LABA and an inhaled corticosteroid that has been shown to be effective in improving lung function and symptoms in patients with asthma 2, 3.
• Budesonide/formoterol is another combination of an inhaled corticosteroid and a LABA that has been shown to be effective in reducing severe exacerbations and providing fast symptom relief 4.
• Inhaled corticosteroids, such as fluticasone propionate, are also effective in reducing inflammation and improving lung function in patients with asthma 2, 3.

Treatment Strategies

• The GINA guidelines recommend a stepwise approach to asthma management, with increasing intensity of treatment based on symptom severity and control 4.
• Maintenance and reliever therapy (MART) or symbicort maintenance and reliever therapy (SMART) are strategies that involve using a combination of an inhaled corticosteroid and a LABA for both maintenance and relief 4.
• Patient education and adherence to treatment are crucial for effective asthma management and prevention of exacerbations 4.