From the Guidelines
Treatment for asthma exacerbation should prioritize the use of systemic corticosteroids, such as methylprednisolone 125 mg or dexamethasone 10 mg, to reduce inflammation, along with short-acting beta-agonists (SABAs) like albuterol, and oxygen therapy to maintain oxygen saturation above 90%. The management of asthma exacerbations involves a step-wise approach, starting with the assessment of severity and the institution of immediate treatment, which may include oxygen, SABAs, and systemic corticosteroids 1. For moderate to severe exacerbations, the early use of systemic corticosteroids is crucial to hasten the resolution of airflow obstruction and reduce the need for hospital admission.
Key components of treatment include:
- Administration of oxygen to maintain saturation above 90%
- Use of SABAs like albuterol, typically 2-4 puffs every 20 minutes for the first hour, then as needed
- Early addition of systemic corticosteroids, such as prednisone 40-60mg daily for adults or 1-2mg/kg/day for children, with no taper needed for short courses
- Consideration of ipratropium bromide for severe exacerbations, particularly if there's no immediate response to SABAs and corticosteroids
- Continuation of maintenance medications during the exacerbation
Monitoring and follow-up are critical, with repeated measurements of lung function and assessment for signs of deterioration or improvement. Patients should be discharged with a prescription for corticosteroid therapy to reduce the risk of recurrence and should follow up with their healthcare provider to review their asthma action plan and adjust maintenance therapy as needed 1. The goal of treatment is to rapidly improve symptoms, prevent hospitalization, and reduce the risk of future exacerbations, thereby improving morbidity, mortality, and quality of life for patients with asthma.
From the FDA Drug Label
Inhaled beta-2 selective agonists and systemically administered corticosteroids are the treatments of first choice for management of acute exacerbations of asthma The results of controlled clinical trials on the efficacy of adding intravenous theophylline to inhaled beta-2 selective agonists and systemically administered corticosteroids in the management of acute exacerbations of asthma have been conflicting Most studies in patients treated for acute asthma exacerbations in an emergency department have shown that addition of intravenous theophylline does not produce greater bronchodilation and increases the risk of adverse effects In contrast, other studies have shown that addition of intravenous theophylline is beneficial in the treatment of acute asthma exacerbations in patients requiring hospitalization, particularly in patients who are not responding adequately to inhaled beta-2 selective agonists
The treatment of first choice for acute exacerbations of asthma is inhaled beta-2 selective agonists and systemically administered corticosteroids. The addition of intravenous theophylline may be beneficial in patients requiring hospitalization who are not responding adequately to first-line treatments, but it may also increase the risk of adverse effects 2.