What is the epidose (emergency dose) for asthma?

From the Guidelines

For acute asthma exacerbations, the recommended emergency dose is 2 g of corticosteroids over 20 minutes in adults and 25 to 75 mg/kg in children (up to a maximum of 2 g) 1. The dose of corticosteroids is crucial in managing asthma exacerbations, and the recommended dose is based on the most recent and highest quality study available.

• The study published in the Journal of Allergy and Clinical Immunology in 2009 provides guidelines for the management of asthma exacerbations, including the recommended dose of corticosteroids 1.
• The guidelines state that there is no known advantage for higher doses of corticosteroids in severe asthma exacerbations, and that the total course of systemic corticosteroids may last from 3 to 10 days 1.
• Another study published in the same journal in 2009 provides a table of dosages for asthma exacerbations, including the recommended dose of corticosteroids 2.
• However, the most recent and highest quality study recommends a dose of 2 g of corticosteroids over 20 minutes in adults and 25 to 75 mg/kg in children (up to a maximum of 2 g) 1.
• It is essential to note that the dose of corticosteroids should be individualized based on the patient's response and medical history.
• Additionally, other treatments such as albuterol and ipratropium bromide may be used in conjunction with corticosteroids to manage asthma exacerbations 2.
• The use of heliox-driven albuterol nebulization may also be considered in severe asthma exacerbations, although the evidence is limited 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0. 5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0. 3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary

The emergency dose for anaphylaxis is 0.3 to 0.5 mg for adults and children 30 kg or more, and 0.01 mg/kg (up to 0.3 mg) for children less than 30 kg. However, the question asks for the epidose for asthma, which is not directly addressed in the provided drug label. The label discusses the use of epinephrine for anaphylaxis, not specifically for asthma. Therefore, based on the provided information, no conclusion can be drawn regarding the epidose for asthma 3.

From the Research

Asthma Emergency Dose

• The emergency dose for asthma, also known as the epidose, typically involves the administration of short-acting beta-agonists, such as salbutamol, via a nebulizer or inhaler 4, 5.
• In cases of severe asthmatic exacerbation, the treatment may include the addition of ipratropium bromide and magnesium sulfate, as well as systemic corticosteroids 5, 6.
• For patients who do not respond adequately to nebulized salbutamol, alternative treatments such as nebulized racemic epinephrine may be considered 6.
• Epinephrine inhalers, such as Primatene Mist, are approved for asthma treatment in some countries, but their use in emergency sets for patients with anaphylaxis is still controversial due to concerns about their effectiveness in reaching plasma concentrations needed for hemodynamic stabilization 7.

Dosage and Administration

• The dosage and administration of asthma emergency medications may vary depending on the severity of the exacerbation and the patient's response to treatment 4, 5.
• Short-acting beta-agonists are typically administered via a nebulizer or inhaler, with a dose of 2.5-5mg via nebulizer or 2-4 puffs via inhaler, repeated as needed 5.
• Systemic corticosteroids, such as prednisolone, may be administered orally or intravenously, with a dose of 40-50mg per day for adults 5, 8.