What are the treatment options for a dry sore throat in an asthmatic patient admitted to the hospital for exacerbation?

Treatment of Dry Sore Throat in Asthmatic Patients Hospitalized for Exacerbation

For patients with asthma exacerbation and dry sore throat, administer supplemental oxygen to maintain SaO₂ >90%, provide inhaled beta-agonists with ipratropium bromide, and systemic corticosteroids, while avoiding unnecessary treatments like aggressive hydration, mucolytics, or chest physiotherapy. 1

Primary Treatment Components

• Administer oxygen through nasal cannulae or mask to maintain oxygen saturation >90% (>95% in pregnant patients or those with heart disease) 2
• Provide inhaled short-acting beta-agonists (SABA) such as salbutamol 5 mg or terbutaline 10 mg via nebulizer or metered-dose inhaler with spacer every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 2
• Add ipratropium bromide 0.5 mg to nebulized SABA for severe exacerbations, which has been shown to reduce hospitalization rates 1, 2
• Administer systemic corticosteroids early in the treatment course - oral prednisolone 30-60 mg daily for adults 1, 3

Specific Management for Dry Sore Throat

• Avoid treatments specifically contraindicated by guidelines for asthma exacerbations, including:

  • Aggressive hydration 1
  • Mucolytics 1
  • Chest physiotherapy 1
  • Sedation 1, 4

• Avoid treatments that lack evidence of benefit and may worsen symptoms:

  • Drinking large volumes of liquids 1
  • Breathing warm, moist air 1
  • Over-the-counter antihistamines or cold remedies 1

Monitoring and Assessment

• Regularly assess lung function with serial measurements of PEF or FEV1, which is the strongest predictor of hospitalization need 1, 2
• Monitor oxygen saturation continuously until a clear response to bronchodilator therapy has occurred 5, 2
• Assess for signs of severe exacerbation including inability to complete sentences in one breath, respiratory rate >25/min, heart rate >110/min, and PEF <50% of predicted 1

Considerations for Hospital Management

• For patients with moderate exacerbations (FEV1 or PEF 40-69%), continue SABA every 60 minutes and oral systemic corticosteroids 1
• For severe exacerbations (FEV1 or PEF <40%), provide oxygen, nebulized SABA plus ipratropium hourly or continuously, and systemic corticosteroids 1, 2
• Consider adjunctive therapies for severe exacerbations unresponsive to initial treatment:
  • Intravenous magnesium sulfate (2g over 20 minutes in adults) 1, 6
  • Heliox (helium-oxygen mixture) to decrease work of breathing 1, 5

Discharge Planning

• Before discharge, ensure patient has been on discharge medication for 24 hours with inhaler technique checked and recorded 1
• Verify PEF >75% of predicted or personal best with diurnal variability <25% 1
• Provide patient with own PEF meter and written asthma action plan 1, 7
• Arrange follow-up with primary care provider within 1 week 1

Important Cautions

• Treatments that are specifically NOT recommended during hospitalization include methylxanthines, antibiotics (except for comorbid conditions), aggressive hydration, chest physical therapy, mucolytics, and sedation 1, 4
• While inhaled ipratropium bromide is helpful in the emergency setting, it does not provide additional benefit after hospitalization for severe exacerbation 1
• Recognize that dry sore throat may be exacerbated by oxygen therapy and inhaled medications; however, these treatments should not be withheld as they are essential for managing the asthma exacerbation 4, 8