What is the treatment for acute asthma exacerbation?

From the Guidelines

The treatment of acute asthma exacerbation should involve a stepwise approach focusing on rapid bronchodilation and reducing airway inflammation, with initial management including administering short-acting beta-agonists (SABAs) like albuterol (salbutamol) via metered-dose inhaler with spacer or nebulizer, and early administration of systemic corticosteroids, such as methylprednisolone 125 mg IV for severe cases, as recommended by the 2010 American Heart Association guidelines 1.

Key Components of Treatment

• Administering short-acting beta-agonists (SABAs) like albuterol (salbutamol) via metered-dose inhaler with spacer or nebulizer, typically 2.5-5 mg every 20 minutes for three doses, then as needed, as supported by the National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations 1
• Early administration of systemic corticosteroids, such as methylprednisolone 125 mg IV for severe cases, to reduce airway inflammation, as recommended by the 2010 American Heart Association guidelines 1
• Oxygen therapy to maintain oxygen saturation above 92%
• For moderate to severe exacerbations, adding ipratropium bromide 0.5 mg via nebulizer every 20 minutes for three doses, then as needed, as indicated by a recent meta-analysis 1

Monitoring and Assessment

• Continuous monitoring of vital signs, oxygen saturation, and response to treatment is essential
• Patients should be assessed for hospitalization if they have poor response to initial treatment, persistent hypoxemia, or high-risk features, as emphasized by the National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations 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 use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm

The treatment for acute asthma exacerbation is albuterol inhalation solution administered by nebulization. The recommended dosage is 2.5 mg for adults and children weighing at least 15 kg, administered three to four times daily. For children weighing less than 15 kg, a lower dose of 0.5% albuterol inhalation solution may be used. If symptoms persist or worsen, medical advice should be sought immediately 2.

From the Research

Treatment for Acute Asthma Exacerbation

The treatment for acute asthma exacerbation involves a combination of medications and therapies. The main goals of treatment are to:

• Relieve airflow obstruction
• Reduce airway inflammation
• Maintain adequate arterial oxygen saturation

Medications Used

• Short-acting beta-agonists: provide rapid relief of symptoms and are the first line of treatment for acute asthma exacerbation 3, 4, 5, 6, 7
• Systemic corticosteroids: reduce airway inflammation and are essential for preventing future relapses 3, 5, 6, 7
• Short-acting muscarinic antagonists: can be used in combination with short-acting beta-agonists to provide additional relief 5, 7
• Intravenous magnesium sulfate: may be used in severe exacerbations 5
• Helium-oxygen mixtures: may be used in patients who do not respond to standard therapies or those with severe disease 5, 7

Administration of Medications

• Ad-lib administration of short-acting beta-agonists: may be as effective as regular, scheduled administration in patients with acute asthma exacerbation 3
• Nebulized medications: can be used to deliver short-acting beta-agonists and short-acting muscarinic antagonists 7
• Oral or parenteral corticosteroids: should be considered early in treatment if patients do not respond to initial therapy 7

Key Considerations

• Assessment of severity: is crucial in determining the appropriate treatment for acute asthma exacerbation 6
• Response to treatment: should be closely monitored to adjust therapy as needed 6
• Prevention of future relapses: is an important goal of treatment, and systemic corticosteroids play a key role in achieving this goal 6