What are the medications for acute asthma exacerbation?

From the Guidelines

Medications for asthma exacerbation include short-acting beta-agonists (SABAs) like albuterol (2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed) as first-line treatment to quickly relax airway muscles, as recommended by the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations 1. The treatment of asthma exacerbations involves a combination of medications to address both bronchoconstriction and inflammation.

• Short-acting beta-agonists (SABAs) such as albuterol are the first-line treatment for acute asthma exacerbations, with dosages of 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed via nebulizer, or 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed via metered-dose inhaler (MDI) 1.
• Systemic corticosteroids, such as prednisone or methylprednisolone, are crucial to reduce inflammation, with typical dosages of 40-60 mg daily for 5-7 days 1.
• For moderate to severe exacerbations, ipratropium bromide (a short-acting anticholinergic) can be added to albuterol treatments, with dosages of 0.25-0.5 mg every 20 minutes for 3 doses, then as needed via nebulizer, or 4-8 puffs every 20 minutes as needed up to 3 hours via MDI 1.
• Oxygen therapy is necessary if oxygen saturation falls below 92%, and in severe cases unresponsive to initial treatment, magnesium sulfate (2g IV over 20 minutes) may help relax airway muscles 1.
• For life-threatening exacerbations, epinephrine (0.3-0.5mg IM) might be needed, although its use is typically reserved for anaphylaxis or severe allergic reactions 1. After the acute phase, inhaled corticosteroids should be initiated or intensified to prevent recurrence, as they are the preferred controller medication for persistent asthma and have been shown to improve asthma control more effectively than any other single long-term control medication 1. These medications work together to address the two main components of asthma: bronchoconstriction (through bronchodilators) and inflammation (through corticosteroids), providing both immediate relief and reducing the underlying inflammatory process.

From the FDA Drug Label

As with other inhaled beta-adrenergic agonists, albuterol sulfate inhalation solution can produce paradoxical bronchospasm, which can be life threatening. The action of albuterol sulfate inhalation solution may last up to six hours, and therefore it should not be used more frequently than recommended

Asthma Exacerbation Medication:

• Albuterol (INH) is used for asthma exacerbation, however, it is essential to use it with caution and as recommended by a physician.
• The medication should not be used more frequently than recommended, and medical consultation should be sought promptly if symptoms get worse 2, 2.
• Other anti-asthma medicines should not be used unless prescribed.
• Key Considerations:
  • Use with caution in patients with cardiovascular disorders
  • May produce paradoxical bronchospasm
  • May cause significant hypokalemia in some patients
  • Should not be used concomitantly with other sympathomimetic aerosol bronchodilators or epinephrine

From the Research

Medications for Asthma Exacerbation

• Corticosteroids: A short course of corticosteroids following assessment for an asthma exacerbation significantly reduces the number of relapses to additional care, hospitalizations, and use of short-acting beta(2)-agonist without an apparent increase in side effects 3.
• Ipratropium bromide: The addition of ipratropium bromide to beta(2)-agonist therapy is effective in the treatment of acute asthma exacerbation in children and adults, with a modest statistical improvement in airflow obstruction and a decrease in hospitalization rates 4, 5.
• Beta(2)-agonists: Short-acting beta(2)-agonists are used to rapidly reverse bronchospasm and reduce airway inflammation in acute asthma exacerbations 6.
• Combination therapies: Combination therapies with inhaled corticosteroids and either long-acting beta(2) agonists or leukotriene receptor antagonists are commonly used to help patients maintain control of their asthma 7.
• Muscarinic antagonists and magnesium sulfate: The addition of a short-acting muscarinic antagonist and magnesium sulfate infusion has been associated with fewer hospitalizations in patients with severe exacerbations 6.

Treatment Strategies

• Home management: Asthma action plans help patients triage and manage symptoms at home, with the use of inhaled corticosteroid/formoterol combination or short-acting beta(2) agonist 6.
• Office setting: Assessment of exacerbation severity and treatment with short-acting beta(2) agonist and oxygen, with repeated doses of the short-acting beta(2) agonist every 20 minutes for one hour and oral corticosteroids 6.
• Acute care facility: Treatment with oxygen, frequent administration of a short-acting beta(2) agonist, and corticosteroids, with the addition of a short-acting muscarinic antagonist and magnesium sulfate infusion in severe cases 6.