From the Guidelines
Treatment for asthma exacerbations should involve prompt use of short-acting beta-agonists (SABAs) like albuterol, typically 2-4 puffs every 20 minutes for the first hour, then every 1-4 hours as needed, in addition to oral corticosteroids such as prednisone (40-60mg daily for 5-7 days for adults) for moderate to severe exacerbations.
Key Components of Treatment
- Oxygen therapy is recommended if oxygen saturation falls below 92% 1.
- In severe cases, ipratropium bromide may be added to albuterol treatments, and intravenous magnesium sulfate (2g over 20 minutes) might be considered 1.
- Patients should continue their maintenance medications throughout the exacerbation.
- If symptoms worsen despite treatment, breathing becomes very difficult, lips or fingernails turn blue, or the person can't speak in complete sentences, immediate emergency care is necessary.
Rationale for Treatment
These medications work by quickly opening airways (bronchodilators) and reducing inflammation (corticosteroids), addressing both components of asthma exacerbations 1.
Follow-Up Care
After the acute episode resolves, patients should follow up with their healthcare provider to review their asthma action plan and adjust maintenance therapy if needed.
Special Considerations
The dose and frequency of administration, along with the frequency of patient monitoring, differ depending on the severity of the exacerbation 1. In addition to these treatments, therapy with inhaled ipratropium bromide or other agents might also be necessary in severe exacerbations 1. Systemic corticosteroids are the only treatment for the inflammatory component of asthma proven to be effective for acute asthma exacerbations, and should be administered early 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 treatment for an asthma exacerbation is 2.5 mg of albuterol administered three to four times daily by nebulization for adults and children weighing at least 15 kg 2.
- The dose can be repeated as needed to control recurring bouts of bronchospasm.
- If a previously effective dosage regimen fails to provide the usual relief, medical advice should be sought immediately.
From the Research
Treatment for Asthma Exacerbation
The treatment for asthma exacerbation involves a combination of medications and therapies. The mainstay of treatment includes:
- Short-acting beta agonist therapy (albuterol) and steroids, as stated in 3
- Inhaled corticosteroids and long-acting beta2 agonists, which have been shown to reduce the risk of asthma exacerbations, as mentioned in 4, 5, 6
- The use of a spacer with handheld inhalers, as recommended in 3
- Additional therapies such as leukotriene receptor antagonists, anti-IgE mAbs, and anti-IL-5 mAb, which have been demonstrated to reduce severe asthma exacerbations, as discussed in 6
Severity of Asthma Exacerbations
The severity of asthma exacerbations is determined by:
- Clinical presentation, as stated in 3
- Peak expiratory flow rates, as mentioned in 3
- Vital signs, as noted in 3
- The use of spirometry to aid in diagnosis and measurement of severity, but not solely relied upon to make disposition decisions, as discussed in 3
Additional Therapies
Additional therapies that may be used in the treatment of asthma exacerbations include:
- Inhaled ipratropium, which has been shown to decrease hospitalization rates, as mentioned in 3
- Noninvasive positive pressure ventilation, which may be utilized in patients with moderate to severe exacerbations, as stated in 3
- Ketamine, which may be considered in severe exacerbations, but should not be used routinely, as noted in 3
- Magnesium sulfate, which may be beneficial in severe asthma exacerbations, but routine use for mild to moderate exacerbations is not indicated, as discussed in 3, 4