What is the recommended rescue medication for an asthma attack?

Rescue Medication for Asthma Attacks

Inhaled short-acting beta-agonists (SABAs) such as salbutamol (albuterol) are the most effective rescue medications for rapid reversal of airflow obstruction and prompt relief of asthma attack symptoms. 1

First-Line Rescue Treatment

Short-Acting Beta-Agonists (SABAs)

• Medication of choice: Salbutamol (albuterol) or terbutaline
• Dosage:
  • Adults: 5 mg salbutamol or 10 mg terbutaline via nebulizer 1
  • Alternative delivery: 4-8 puffs via metered-dose inhaler with spacer device 1
• Administration frequency: Every 20 minutes for 3 doses initially, then as needed 1
• Mechanism: Provides rapid bronchodilation by relaxing airway smooth muscle

Delivery Methods

1. Nebulizer: Preferred in severe attacks, especially when oxygen-driven
2. Metered-dose inhaler (MDI) with spacer: As effective as nebulizer in mild-to-moderate exacerbations with proper technique 1
3. If no nebulizer available: 2 puffs of beta-agonist via large volume spacer, repeated 10-20 times 1

Additional Rescue Medications

For Moderate to Severe Attacks

• Systemic corticosteroids: Should be added promptly
  • Oral prednisolone: 30-60 mg daily 1
  • IV hydrocortisone: 200 mg (if unable to take oral medication) 1
  • Duration: Until lung function returns to previous best (typically 7-21 days) 1

For Severe or Life-Threatening Attacks

• Ipratropium bromide: Add to SABA therapy
  • Dosage: 0.5 mg nebulized every 20 minutes for 3 doses, then as needed 1
  • Particularly beneficial in first few hours of severe exacerbations 1

Assessment of Attack Severity

Mild to Moderate

• Speech normal
• Pulse <110 beats/min
• Respiratory rate <25 breaths/min
• PEF >50% of predicted or personal best 1

Severe

• Cannot complete sentences in one breath
• Pulse >110 beats/min
• Respiratory rate >25 breaths/min
• PEF <50% of predicted or personal best 1

Life-Threatening

• Silent chest, cyanosis, feeble respiratory effort
• Confusion, drowsiness
• PEF <33% of predicted or personal best 1

Treatment Algorithm

1. Assess severity using objective measures (PEF, respiratory rate, heart rate)
2. Administer SABA via appropriate delivery method based on severity
3. Reassess after 15-30 minutes
4. If improving: Continue SABA every 4-6 hours as needed
5. If not improving or worsening:
   • Add systemic corticosteroids
   • Add ipratropium bromide
   • Consider hospital admission
6. Monitor response through symptoms and PEF measurements

Common Pitfalls to Avoid

• Underestimating severity: Delay in appropriate treatment can be fatal 1
• Overreliance on SABAs: Increasing use (more than twice weekly) indicates inadequate asthma control and need for anti-inflammatory therapy 1
• Delaying corticosteroids: Should be administered promptly in moderate to severe exacerbations 1
• Using sedatives: Avoid all sedatives in asthma attacks as they can worsen respiratory depression 1
• Inadequate monitoring: Failure to objectively assess response to treatment 1

Follow-up After an Attack

• Monitor symptoms and PEF on a chart
• Review and update asthma action plan
• Schedule follow-up within 24-48 hours for severe attacks
• Evaluate need for adjustment of maintenance therapy 1

Remember that increasing use of rescue medication (more than twice weekly) indicates poor asthma control and should prompt review of maintenance therapy to address the underlying inflammation 1.