From the Guidelines
The initial treatment for acute asthma exacerbation should include administration of short-acting beta-agonists (SABAs) such as salbutamol 5 mg or terbutaline 10 mg via an oxygen-driven nebuliser, along with systemic corticosteroids like prednisolone 1-2 mg/kg body weight orally, and high flow oxygen via face mask to maintain oxygen saturation ≥92%. This approach is based on the guidelines for the management of asthma, which emphasize the importance of early treatment with bronchodilators and corticosteroids to reduce inflammation and improve symptoms 1.
Key Components of Initial Treatment
- Short-acting beta-agonists (SABAs) to rapidly open airways
- Systemic corticosteroids to reduce inflammation and swelling in the airways
- High flow oxygen to maintain adequate oxygen saturation
- Monitoring of vital signs, oxygen saturation, and response to therapy
Additional Considerations
- For moderate to severe exacerbations, adding ipratropium bromide to the SABA treatment can provide additional bronchodilation, as suggested by more recent guidelines 1.
- The choice between oral and intravenous corticosteroids may depend on the severity of the exacerbation and the patient's ability to tolerate oral medications.
- Continuous monitoring and reassessment after initial treatment are crucial to determine the need for hospitalization or discharge with a short course of oral corticosteroids and close follow-up.
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 initial treatment for acute asthma exacerbation is albuterol inhalation solution administered by nebulization, with a usual dosage of 2.5 mg for adults and children weighing at least 15 kg. Key points include:
- Administration of the entire contents of one sterile unit-dose vial (3 mL of 0.083% inhalation solution)
- Delivery over approximately 5 to 15 minutes 2
From the Research
Initial Treatment for Acute Asthma Exacerbation
The initial treatment for acute asthma exacerbation typically involves a combination of medications to relieve symptoms and reduce airway inflammation. Key components of this treatment include:
- Inhaled short-acting beta-agonists (SABAs) to quickly relieve bronchospasm and improve breathing 3, 4, 5, 6.
- Systemic corticosteroids to reduce airway inflammation and prevent future relapses 3, 4.
- Supplemental oxygen to maintain adequate arterial oxygen saturation 4.
Administration of Short-Acting Beta-Agonists
The administration of SABAs can be either regular and scheduled or as-needed (ad-lib). Studies have shown that ad-lib administration of albuterol can be as effective as regular, scheduled administration in managing asthma exacerbation, while also reducing the total dose of beta-agonists received by the patient 3. However, in cases of severe asthma exacerbation, continuous nebulization of SABAs may be more effective than intermittent nebulization in achieving faster relief and potentially shorter hospital stays 6.
Combination Therapy with Anticholinergics
Combining SABAs with short-acting anticholinergics (SAACs) may offer additional benefits in reducing hospitalizations and improving pulmonary function in adults with acute asthma, particularly those with severe exacerbations 7. This combination therapy can lead to improved forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF), and reduced need for return visits to the emergency department. However, it is associated with a higher likelihood of adverse events such as tremor, agitation, and palpitations.
Considerations for Treatment
The choice of treatment should be tailored to the severity of the asthma exacerbation and the patient's response to initial therapy. For patients who do not respond well to initial treatment with SABAs, considering a full beta(2)-agonist like isoproterenol may offer therapeutic advantages 5. Additionally, the role of anthicolinergics is emerging as a potential adjunct in the management of acute asthma exacerbation 4.