From the Guidelines
The management of acute asthma exacerbation involves immediate treatment with oxygen, inhaled β2-agonists, and systemic corticosteroids.
Key Components of Management
- Assessment and Monitoring: Evaluate patients immediately, with treatment instituted promptly based on the severity of the exacerbation 1.
- Medications:
- Inhaled β2-agonists: Administered as needed, with the dose and frequency dependent on the severity of the exacerbation.
- Systemic Corticosteroids: The total course may last from 3 to 10 days, with no need to taper the dose for courses less than 1 week 1.
- Intravenous β2-agonists: Not recommended due to the danger of myocardial toxicity 1.
- Oxygen Therapy: Administered as needed to maintain adequate oxygenation.
- Heliox-driven Albuterol Nebulization: Can be considered in patients with severe exacerbations, although the evidence is limited 1.
Discharge Criteria
Patients can be discharged if FEV1 or PEF results are 70% or more of predicted value or personal best and symptoms are minimal or absent, with a prescription for 3 to 10 days of corticosteroid therapy to reduce the risk of recurrence 1.
Special Considerations
- Intubation: Should be done semielectively and before respiratory arrest occurs, with consultation with a physician expert in ventilator management 1.
- Ventilator Strategy: "Permissive hypercapnia" or "controlled hypoventilation" is recommended to provide adequate oxygenation while minimizing airway pressures and the possibility of barotrauma 1.
From the Research
Management of Acute Asthma Exacerbation
The management of acute asthma exacerbation involves several key components, including:
- Prompt recognition and rapid reversal of airflow obstruction 2, 3
- Use of short-acting beta-agonists, oxygen, and corticosteroids as the foundation of treatment 2, 3, 4
- Consideration of anticholinergics and magnesium sulfate for nonresponders 2, 3, 4
- Initiation or intensification of long-term controller therapy to prevent relapses and future episodes 2, 3
- Treatment of comorbid conditions and avoidance of triggers to prevent exacerbations 2, 3, 5
- Patient education and cooperation, including written asthma plans and proper inhalation techniques, to enhance adherence and prevent future episodes 2, 3, 5
Treatment Options
Treatment options for acute asthma exacerbation may include:
- Short-acting beta-agonists, such as albuterol, to rapidly reverse airflow obstruction 2, 3, 4
- Corticosteroids, such as prednisone, to reduce inflammation 2, 3, 4
- Anticholinergics, such as ipratropium, to help nonresponders 2, 3, 4
- Magnesium sulfate to help nonresponders 4
- Combination inhalers, such as formoterol and budesonide, for flexible dosing and daily controller medication 2
Special Considerations
Special considerations in the management of acute asthma exacerbation include:
- Early recognition and intervention in the emergency department (ED) to prevent hospital admission and ICU admission 6
- Continuous monitoring and appropriate disposition in the ED 6
- Multifaceted transitional care to optimize subacute and chronic asthma management after ED discharge 6
- Consideration of special populations, such as young children, pregnant women, and the elderly, in the management of acute asthma exacerbation 6