Asthma emergency management: Difference between revisions
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{{Asthma}} | {{Asthma}} | ||
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com] | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com] | ||
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When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:<!-- | When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:<!-- | ||
--><ref name=rodrigo>Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. ''Chest''. 2004;125(3):1081-102. PMID 15006973</ref> | --><ref name=rodrigo>Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. ''Chest''. 2004;125(3):1081-102. PMID 15006973</ref> | ||
* [[ | * [[Oxygen]] to alleviate the hypoxia (but not the asthma ''per se'') that results from extreme asthma attacks; | ||
* | * Nebulized [[salbutamol]] or [[terbutaline]] (short-acting beta-2-agonists), often combined with ipratropium (an anticholinergic); | ||
* | * Systemic steroids, oral or intravenous ([[prednisone]], [[prednisolone]], [[methylprednisolone]], [[dexamethasone]], or hydrocortisone). Some research has looked into an alternative inhaled route.<ref>{{cite journal |author=Rodrigo G |title=Comparison of inhaled fluticasone with intravenous hydrocortisone in the treatment of adult acute asthma |journal=Am J Respir Crit Care Med |volume=171 |issue=11 |pages=1231–6 |year=2005 |pmid=15764724}}</ref> | ||
* | * Other bronchodilators that are occasionally effective when the usual drugs fail: | ||
** | ** Intravenous salbutamol | ||
** | ** Nonspecific beta-agonists, injected or inhaled ([[epinephrine]], isoetharine, [[isoproterenol]], [[metaproterenol]]); | ||
** | ** Anticholinergics, IV or nebulized, with systemic effects ([[glycopyrrolate]], [[atropine]], [[ipratropium]]); | ||
** | ** Methylxanthines ([[theophylline]], [[aminophylline]]); | ||
** | ** Inhalation anesthetics that have a bronchodilatory effect ([[isoflurane]], [[halothane]], [[enflurane]]); | ||
** | ** The dissociative anaesthetic [[ketamine]], often used in [[endotracheal tube]] induction | ||
** [[ | ** [[Magnesium sulfate]], intravenous; and | ||
* | * Intubation and mechanical ventilation, for patients in or approaching respiratory arrest. | ||
* Heliox, a mixture of helium and oxygen, may be used in a hospital setting. It has a more laminar flow than ambient air and moves more easily through constricted airways. | * Heliox, a mixture of helium and oxygen, may be used in a hospital setting. It has a more laminar flow than ambient air and moves more easily through constricted airways. | ||
Revision as of 13:36, 27 September 2011
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H. [2]
Emergency treatment
When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:[1]
- Oxygen to alleviate the hypoxia (but not the asthma per se) that results from extreme asthma attacks;
- Nebulized salbutamol or terbutaline (short-acting beta-2-agonists), often combined with ipratropium (an anticholinergic);
- Systemic steroids, oral or intravenous (prednisone, prednisolone, methylprednisolone, dexamethasone, or hydrocortisone). Some research has looked into an alternative inhaled route.[2]
- Other bronchodilators that are occasionally effective when the usual drugs fail:
- Intravenous salbutamol
- Nonspecific beta-agonists, injected or inhaled (epinephrine, isoetharine, isoproterenol, metaproterenol);
- Anticholinergics, IV or nebulized, with systemic effects (glycopyrrolate, atropine, ipratropium);
- Methylxanthines (theophylline, aminophylline);
- Inhalation anesthetics that have a bronchodilatory effect (isoflurane, halothane, enflurane);
- The dissociative anaesthetic ketamine, often used in endotracheal tube induction
- Magnesium sulfate, intravenous; and
- Intubation and mechanical ventilation, for patients in or approaching respiratory arrest.
- Heliox, a mixture of helium and oxygen, may be used in a hospital setting. It has a more laminar flow than ambient air and moves more easily through constricted airways.