RSV Treatment in Adult Asthma Exacerbation

Introduction to RSV and Asthma

The American College of Physicians and other medical societies acknowledge that RSV is a significant trigger for asthma exacerbations in adults, particularly those with underlying respiratory disease, with adults with asthma having 7-8 times greater risk of RSV-associated hospitalization compared to those without asthma 2, 1

The American Thoracic Society recommends that management of RSV in adults with asthma exacerbations focuses on treating the asthma exacerbation itself with standard therapy, including systemic corticosteroids, bronchodilators, and oxygen, while recognizing that RSV is a trigger rather than a target for treatment 1
The European Respiratory Society suggests administering oxygen via nasal cannula or mask to maintain SpO₂ >90% (>95% in pregnant patients or those with heart disease) 3
The National Asthma Education and Prevention Program advises giving albuterol 2.5-5 mg via nebulizer or 4-8 puffs via MDI with spacer every 20 minutes for 3 doses, with both delivery methods being equally effective when properly administered 3
The British Thoracic Society recommends starting systemic corticosteroids immediately, such as prednisolone 40-60 mg orally (or IV hydrocortisone 200 mg if unable to take oral), which is critical because corticosteroids address the underlying inflammatory pathology that beta-agonists do not impact 4, 3

The American Academy of Allergy, Asthma, and Immunology suggests adding ipratropium bromide 0.5 mg via nebulizer (or 8 puffs via MDI) every 20 minutes for 3 doses, then as needed, which reduces hospitalizations, particularly in patients with severe airflow obstruction 3

The Global Initiative for Asthma (GINA) encourages adults with asthma to receive RSV vaccination according to local immunization schedules, with efficacy of 82.6% against RSV-associated lower respiratory tract disease in the first season for adults ≥60 years 2, 1, 6

The American College of Chest Physicians recommends continuing oral corticosteroids for 5-10 days after discharge, and when used in short courses up to two weeks, oral steroids do not need to be tapered and can be stopped from full dosage 3, 4

The Society of Hospital Medicine advises that patients should not be discharged until PEF reaches ≥70% of predicted or personal best, symptoms are minimal or absent, and oxygen saturation is stable on room air, and to observe for 30-60 minutes after the last bronchodilator dose to ensure stability 3
The American Academy of Family Physicians recommends providing a written asthma action plan, reviewing inhaler technique, and ensuring patients continue or initiate inhaled corticosteroids at discharge 3