Practice Guidance Overview
Severe exacerbations of asthma are life-threatening medical emergencies, which are most safely managed in an acute care setting.
GINA 2022 - Treatment in acute care settings part 1: oxygen, beta2-agonists, epinephrine and corticosteroids (2)
The following treatments are usually administered concurrently to achieve rapid improvement:
GINA 2022 - Treatment in acute care settings part 2: other treatments. Anticholinergics, aminophylline and theophylline, magnesium, helium, etc. (2)
For adults and children with moderate-severe exacerbations, treatment in the emergency department with both SABA and ipratropium, a short-acting anticholinergic, was associated with fewer hospitalizations (Evidence A for adults; Evidence B for adolescents/children) and greater improvement in PEF and FEV1 compared with SABA alone. (Evidence A, adults/adolescents) For children hospitalized for acute asthma, no benefits were seen from adding ipratropium to SABA, including no reduction in length of stay,667 but the risk of nausea and tremor was reduced.
ICS: inhaled corticosteroids; ICU: intensive care unit; IV: intravenous; O2: oxygen; PEF: peak expiratory flow; FEV1: forced expiratory volume in 1 sec.
Summary of Standard Pharmacotherapy: The First Hour in the ED
Recommended resources about the crashing asthmatic in emergency medicine