From the Guidelines
The best treatment approach for a patient with an exacerbation of moderate persistent asthma complicated by an upper respiratory tract infection and showing only partial response to albuterol is a short course of oral corticosteroids along with intensified bronchodilator therapy. This approach is based on the guidelines for the diagnosis and management of asthma, which recommend the use of oral systemic corticosteroids for moderate and severe exacerbations to speed recovery and prevent recurrence of exacerbations 1. The patient should be initiated on prednisone 40-60mg daily for 5-7 days, while continuing albuterol treatments every 4-6 hours as needed, with the option to increase the frequency to every 2-4 hours temporarily for immediate symptom relief 1. Additionally, the patient should receive an inhaled corticosteroid (ICS) such as fluticasone 250mcg twice daily or equivalent, possibly combined with a long-acting beta-agonist (LABA) like salmeterol in a combination inhaler, to address the underlying inflammation and provide long-term control of symptoms. The upper respiratory infection should be managed symptomatically unless bacterial infection is suspected. This treatment approach is supported by the expert panel report 3 (EPR-3) guidelines, which emphasize the importance of reducing airway inflammation and providing bronchodilation for symptom relief in the management of asthma exacerbations 1. Key points to consider in the treatment approach include:
- The use of oral corticosteroids to reduce airway inflammation and prevent recurrence of exacerbations
- The continuation of bronchodilator therapy with albuterol to relieve bronchoconstriction
- The addition of an inhaled corticosteroid (ICS) and possibly a long-acting beta-agonist (LABA) to provide long-term control of symptoms
- The management of the upper respiratory infection symptomatically unless bacterial infection is suspected.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Approach
The treatment approach for a patient with an exacerbation of moderate persistent asthma, upper respiratory tract infection, and partial response to albuterol involves several considerations:
- The use of inhaled corticosteroids, such as beclomethasone, as a regular treatment for patients with mild persistent asthma 2
- The addition of a leukotriene receptor antagonist (LTRA), such as montelukast, to the treatment regimen for patients with moderate asthma not completely controlled with inhaled corticosteroids 3
- The potential benefit of adding ipratropium bromide to albuterol and corticosteroid therapy in children hospitalized due to an acute asthma exacerbation, although one study found no significant difference between groups 4
- The dose response of patients to oral corticosteroid treatment during exacerbations of asthma, with higher doses showing greater improvement in peak expiratory flow rate 5
- The use of short-term corticosteroid treatment to prevent or reduce the severity of asthma induced by viral respiratory infections in preschool children 6
Medication Options
Medication options for the treatment of exacerbation of moderate persistent asthma include:
- Inhaled corticosteroids, such as beclomethasone
- Leukotriene receptor antagonists, such as montelukast
- Oral corticosteroids, such as prednisolone
- Beta-2 adrenergic receptor agonists, such as albuterol
- Ipratropium bromide, although its benefit in addition to albuterol and corticosteroid therapy is unclear
Treatment Considerations
Treatment considerations for the patient include:
- The severity of the exacerbation and the patient's response to initial treatment
- The presence of an upper respiratory tract infection and the potential benefit of short-term corticosteroid treatment
- The patient's age and the potential use of ipratropium bromide in children
- The dose and duration of oral corticosteroid treatment, with higher doses showing greater improvement in peak expiratory flow rate 5