What is the intravenous drug of choice to prevent hospitalization in an acute asthma exacerbation?

From the Guidelines

The drug of choice for intravenous administration to prevent hospitalization in an acute asthma exacerbation is systemic corticosteroids, such as methylprednisolone or dexamethasone, as they are the only treatment proven to be effective for the inflammatory component of asthma. A typical initial dose of methylprednisolone is 125 mg, and a typical dose of dexamethasone is 10 mg 1. This intervention is particularly beneficial for patients with severe exacerbations who have not responded adequately to initial bronchodilator therapy. Systemic corticosteroids work by reducing airway inflammation, thereby improving airflow and reducing the risk of hospitalization. Before administering systemic corticosteroids, ensure the patient has already received standard first-line treatments including inhaled short-acting beta-agonists (like albuterol) and possibly inhaled anticholinergics. Monitor patients closely during administration for potential side effects. While other treatments, such as magnesium sulfate, may be considered in severe exacerbations, systemic corticosteroids are the primary treatment for reducing inflammation and preventing hospitalization 1.

Some key points to consider when administering systemic corticosteroids include:

• The early use of systemic steroids hastens the resolution of airflow obstruction and may reduce admission to the hospital 1
• The IV route is preferable in patients with severe asthma 1
• Systemic corticosteroids are the only treatment proven to be effective for the inflammatory component of asthma 1
• Other treatments, such as ipratropium bromide, may be used as adjunctive therapy in the emergency care setting, but do not provide additional benefit after a patient is hospitalized for a severe exacerbation 1

From the FDA Drug Label

When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of methylprednisolone sodium succinate for injection is indicated as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. The drug of choice to be given intravenously to prevent hospitalization in an acute asthma exacerbation is methylprednisolone (IV), as it is indicated for the control of severe or incapacitating allergic conditions, including asthma, when oral therapy is not feasible 2.

• Key points:
  • Methylprednisolone (IV) is used for severe or incapacitating allergic conditions
  • It is indicated for asthma when oral therapy is not feasible
  • The use of methylprednisolone (IV) may help prevent hospitalization in acute asthma exacerbation by managing the condition effectively.

From the Research

Treatment Options for Acute Asthma Exacerbations

• The use of intravenous magnesium sulfate has been shown to significantly increase lung function and decrease the necessity of hospitalization in children 3.
• In patients with severe asthma exacerbations, the administration of systemic corticosteroids within one hour of emergency department presentation decreases the need for hospitalization 3.
• Multiple doses of inhaled anticholinergic medication combined with beta2 agonists improve lung function and decrease hospitalization in school-age children with severe asthma exacerbations 3.

Role of Magnesium Sulfate

• Intravenous magnesium can cause bronchodilation in treatment of severe asthma 4.
• The use of isotonic magnesium sulphate as an adjuvant to nebulised salbutamol in severe attacks of asthma has been shown to be effective in enhancing bronchodilator response 4.
• However, the use of nebulised magnesium sulphate in moderate asthma exacerbation as adjuvant treatment showed no benefit to standard treatment in one study 5.

Management of Acute Asthma Exacerbations

• Asthma exacerbations can be classified as mild, moderate, severe, or life threatening, and criteria for exacerbation severity are based on symptoms and physical examination parameters, as well as lung function and oxygen saturation 3.
• The goals of treatment in the ambulatory and emergency department settings are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse 3.