From the Guidelines
Asthma patients do not require specific pre-contrast medication unless they have a history of prior contrast reaction, but ensuring well-controlled asthma before the procedure is crucial to minimize the risk of bronchospasm. The management of asthma before contrast administration should focus on maintaining good asthma control through the patient's regular medication regimen, as routine premedication in asthmatics without prior contrast reactions has not been shown to significantly reduce adverse events 1.
Key Considerations
- Asthma alone is not an indication for premedication before contrast administration.
- Patients with a history of prior contrast reaction should receive a standard premedication regimen: oral prednisone 50 mg at 13,7, and 1 hour before contrast administration, plus diphenhydramine 50 mg 1 hour before the procedure.
- In emergency situations, intravenous methylprednisolone 40 mg and diphenhydramine 50 mg can be given approximately 1 hour before contrast administration.
- Ensuring well-controlled asthma before the procedure is essential to minimize the risk of bronchospasm during contrast administration, and this can be achieved by reviewing the level of asthma control, medication use, and pulmonary function before the procedure 1.
Recommendations for Asthma Management
- Review the level of asthma control, medication use, and pulmonary function before the procedure.
- Provide medications before the procedure to improve lung function if it is not well-controlled.
- Consider a short course of oral systemic corticosteroids if necessary to improve lung function before the procedure.
From the FDA Drug Label
The use of beta-adrenergic-agonist bronchodilators alone may not be adequate to control asthma in many patients. Early consideration should be given to adding anti-inflammatory agents, e.g., corticosteroids, to the therapeutic regimen. The recommended pre-contrast management for a patient with asthma is to consider adding anti-inflammatory agents, such as corticosteroids, to the therapeutic regimen, as beta-adrenergic-agonist bronchodilators alone may not be adequate to control asthma in many patients 2.
- Key points:
- Consider adding anti-inflammatory agents to the therapeutic regimen
- Beta-adrenergic-agonist bronchodilators alone may not be adequate to control asthma
- Corticosteroids may be necessary to control asthma in some patients.
From the Research
Asthma Pre-Contrast Management
- The recommended pre-contrast management for a patient with asthma involves pretreatment with corticosteroids to prevent adverse reactions to contrast media 3.
- A study published in 1984 found that pretreatment with prednisone plus diphenhydramine or prednisone and diphenhydramine plus ephedrine decreased the reaction rate to 9.0% and 3.1%, respectively, during 657 procedures in 563 patients 4.
- Another study published in 1994 found that a two-dose corticosteroid regimen before IV injection of nonionic contrast medium conferred protection against adverse reactions to contrast material, with an overall reaction rate of 1.7% compared to 4.9% in the placebo group 3.
Corticosteroid Regimens
- The use of oral or parenteral corticosteroids is recommended for patients with acute severe asthma, with clinical benefits typically occurring within 6-12 hours 5.
- A study published in 1992 found that low-dose intravenous hydrocortisone (50 mg) was as effective as higher doses (100 mg and 500 mg) in resolving acute severe asthma 6.
- Another study published in 1987 found that early intervention with short courses of prednisone (1 week) improved symptoms in ambulatory patients with asthma incompletely responsive to bronchodilators 7.
Key Considerations
- Emergency equipment should be available for all procedures involving contrast media 4.
- Patients with a history of asthma or allergy should be closely monitored for adverse reactions to contrast media 3.
- The use of corticosteroids in acute severe asthma should be guided by the patient's clinical presentation and medical history 5, 6.