From the Guidelines
For an asthma exacerbation requiring discharge treatment, I recommend a short-acting beta-agonist (SABA) inhaler such as albuterol 2 puffs every 4-6 hours as needed for symptoms, along with a 5-day course of oral corticosteroids like prednisone 40-60mg daily.
Discharge Treatment for Asthma Exacerbation
The treatment approach is based on the most recent guidelines for managing asthma exacerbations, which emphasize the importance of immediate care, close observation, and repeated measurement of lung function 1.
- The primary treatment consists of administration of oxygen, inhaled b2-agonists, and systemic corticosteroids, with the dose and frequency of administration dependent on the severity of the exacerbation.
- Patients can generally be discharged if FEV1 or PEF results are 70% or more of predicted value or personal best and symptoms are minimal or absent 1.
Medication Regimen
- A SABA inhaler such as albuterol is recommended for immediate bronchodilation, with proper inhaler technique crucial for effective medication delivery.
- A 5-day course of oral corticosteroids like prednisone is prescribed to reduce the risk of recurrence and airway inflammation.
- Patients should continue their maintenance inhaler if previously prescribed, typically an inhaled corticosteroid (ICS) like fluticasone or an ICS/long-acting beta-agonist combination like fluticasone/salmeterol.
Follow-up and Monitoring
- Patients should follow up with their primary care provider within 1-2 weeks and seek immediate medical attention if symptoms worsen, breathing becomes difficult, or the rescue inhaler is needed more frequently than every 4 hours.
- This regimen works by providing immediate bronchodilation through the SABA while the corticosteroids reduce airway inflammation, addressing both components of the asthma exacerbation 1.
From the FDA Drug Label
The difference in exacerbations was primarily driven by a reduction in those requiring systemic corticosteroids only. Effect on Exacerbation Trials 4 and 5 included time to first exacerbation as a secondary endpoint, where exacerbation was defined as a deterioration of asthma requiring the use of systemic corticosteroids for at least 3 days or an in-patient hospitalization or emergency department visit due to asthma that required systemic corticosteroids.
The salmeterol inhaler can be used for asthma exacerbation as it has been shown to reduce the number of exacerbations, primarily by reducing the need for systemic corticosteroids 2.
- Key points:
- Reduction in exacerbations requiring systemic corticosteroids
- Salmeterol inhaler can be used for asthma exacerbation
- Trials 4 and 5 demonstrated the efficacy of fluticasone propionate and salmeterol inhalation powder in reducing asthma exacerbations 2
From the Research
Discharge Inhaler for Asthma Exacerbation
- The use of a single inhaler containing a combination of an inhaled corticosteroid (ICS) and a long-acting bronchodilator, such as formoterol, is recommended for both maintenance and quick relief therapy in asthma management 3, 4.
- This approach, known as single maintenance and reliever therapy (SMART), has been shown to reduce the risk of severe asthma exacerbations and provide quick relief of asthma symptoms similar to short-acting β2-agonists such as albuterol 3, 4.
- The SMART regimen typically involves taking a fixed dose of the ICS-long-acting bronchodilator combination as maintenance therapy, with additional inhalations as needed for symptom relief 3, 4.
- Studies have demonstrated the efficacy and safety of SMART with budesonide-formoterol and beclometasone-formoterol, although other ICS-long-acting bronchodilator combinations have not been extensively studied 3, 4.
- Inhaled corticosteroids and long-acting beta-agonists in fixed-dose combinations have been shown to provide improved therapeutic benefits compared to monotherapy alone 5.
- The use of a single inhaler combination regimen, such as budesonide/formoterol, can improve compliance with regular maintenance therapy and reduce the risk of severe exacerbations 6.