What are the medications for decompensation of asthma (bronchial asthma)?

From the Guidelines

For decompensation of asthma, immediate treatment should focus on bronchodilation and reducing inflammation, starting with a short-acting beta-agonist (SABA) like albuterol (2.5-5 mg via nebulizer or 4-8 puffs via MDI with spacer every 20 minutes for 3 doses, then every 1-4 hours as needed) as recommended by the National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations 1.

Medications for Decompensation of Asthma

The following medications are used for decompensation of asthma:

• Short-acting beta-agonists (SABA) such as albuterol, levalbuterol, bitolterol, and pirbuterol
• Systemic corticosteroids such as prednisone and prednisolone
• Anticholinergics such as ipratropium bromide
• Magnesium sulfate for severe exacerbations

Dosages of Medications

The dosages of medications for asthma exacerbations are as follows:

• Albuterol: 2.5-5 mg via nebulizer or 4-8 puffs via MDI with spacer every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• Levalbuterol: 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed 1
• Ipratropium bromide: 0.25-0.5 mg every 20 minutes for 3 doses, then as needed 1

Additional Treatment

Additional treatment for decompensation of asthma includes:

• Supplemental oxygen to maintain oxygen saturation ≥92%
• Continuous monitoring of response to therapy and adjustment of treatment based on clinical improvement or deterioration
• Consideration of intravenous methylprednisolone 60-125 mg every 6 hours for severe cases

Synergistic Effects of Medications

The medications used for decompensation of asthma work synergistically to:

• Relax bronchial smooth muscle (beta-agonists)
• Reduce airway inflammation (corticosteroids)
• Provide additional bronchodilation (anticholinergics)
• Further relax airway smooth muscle (magnesium sulfate)

From the FDA Drug Label

In controlled clinical trials, most patients exhibited an onset of improvement in pulmonary function within 5 minutes as determined by FEV1. FEV1 measurements also showed that the maximum average improvement in pulmonary function usually occurred at approximately 1 hour following inhalation of 2.5 mg of albuterol by compressor-nebulizer and remained close to peak for 2 hours. Clinically significant improvement in pulmonary function (defined as maintenance of a 15% or more increase in FEV1 over baseline values) continued for 3 to 4 hours in most patients and in some patients continued up to 6 hours Published reports of trials in asthmatic children aged 3 years or older have demonstrated significant improvement in either FEV1 or PEFR within 2 to 20 minutes following a single dose of albuterol inhalation solution

The medication for decompensation of asthma (bronchial asthma) is albuterol (INH), which is a beta2-adrenergic agonist that can produce bronchial smooth muscle relaxation and improve pulmonary function 2.

• Key benefits of albuterol include:
  • Rapid onset of action (within 5 minutes)
  • Clinically significant improvement in pulmonary function for 3 to 4 hours in most patients
  • Effective in asthmatic children aged 3 years or older
• Important considerations:
  • May produce paradoxical bronchospasm, which can be life-threatening 2
  • Should be used with caution in patients with cardiovascular disorders 2

From the Research

Medications for Decompensation of Asthma

The medications used to treat decompensation of asthma, also known as bronchial asthma, include:

• Bronchodilators, such as salbutamol (albuterol) and ipratropium bromide, which are administered via a nebulizer or metered-dose inhaler with a spacer 3, 4, 5, 6
• Systemic corticosteroids, which are critical components of therapy and should be administered to all patients with severe asthma exacerbations 3, 4, 5, 6
• Magnesium sulfate, which can be considered in patients with severe asthma exacerbations not responsive to conventional therapy 4, 5, 6
• Subcutaneous and intramuscular β2 agonists, such as terbutaline and epinephrine, which may be considered for patients with severe asthma exacerbation who have poor air entry or are uncooperative with nebulized therapy 5
• Monoclonal anti-IgE antibody (omalizumab) and humanized monoclonal antibodies targeting interleukin pathway, which have shown promise in severe refractory eosinophilic asthma 5

Adjunctive Therapies

Adjunctive therapies that may be considered in the treatment of decompensation of asthma include:

• Non-invasive or invasive ventilation support, which may be necessary in patients with severe exhaustion, deteriorating consciousness, poor air entry, worsening hypoxemia, hypercapnia, and cardiopulmonary arrest 4, 5
• Sedation, which may be indicated to improve comfort, safety, and patient-ventilator synchrony, while decreasing oxygen consumption and carbon dioxide production 4
• Benzodiazepines or propofol, which can be used for sedation of the asthmatic patient, although the choice of sedative should be based on clinical judgement and the patient's individual needs 4

Chronic Treatment of Asthma

The mainstay of chronic treatment of asthma includes:

• Inhaled corticosteroids, which decrease the risk of asthma exacerbations 7
• Bronchodilators, such as salbutamol (albuterol) and formoterol, which can be used as needed or as part of a daily maintenance therapy 7
• Oral montelukasts, which can be used as an add-on therapy in patients with severe asthma 5