Asthma emergency management
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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.