Management of Influenza-Induced Bronchial Asthma Exacerbations

Indications and Benefits

Systemic corticosteroids are a cornerstone therapy for treating the inflammatory component of asthma exacerbations, including those triggered by influenza, and significantly reduce hospital admission rates and risk of relapse when administered early in the treatment course 1, 2
Underuse of corticosteroids is associated with increased mortality in asthma exacerbations 1, 2

For moderate to severe exacerbations, administer oral prednisone 40-60 mg daily until peak expiratory flow (PEF) reaches 70% of predicted or personal best 1, 2
For outpatient management, prescribe a "burst" of 40-60 mg in single or divided doses for a total of 5-10 days 1, 2
For patients who are seriously ill or vomiting, use IV hydrocortisone 200 mg every 6 hours 1
No known advantage exists for IV administration over oral therapy when gastrointestinal absorption is not compromised 2

Assess exacerbation severity based on symptoms and PEF, with categories including mild (PEF ≥70% predicted/personal best), moderate (PEF 40-69% predicted/personal best), severe (PEF <40% predicted/personal best), and life-threatening (PEF <25% predicted/personal best) 3
Treatment approach based on severity includes oral systemic corticosteroids and frequent inhaled SABA for moderate exacerbations, and immediate administration of systemic corticosteroids and frequent inhaled SABA for severe or life-threatening exacerbations 3

Measure PEF 15-30 minutes after starting treatment and then according to response 1
Continue oxygen therapy to maintain SaO₂ >90% (>95% in pregnant women and patients with heart disease) 1
Monitor for clinical improvement, including reduced work of breathing, decreased respiratory rate, and improved PEF 1, 3

Underestimating the severity of asthma exacerbations, which can lead to inadequate treatment 1, 2
Delaying corticosteroid administration, which worsens outcomes 1, 2
Relying on home remedies like drinking large volumes of liquids, breathing warm moist air, or using over-the-counter antihistamines, which have no proven efficacy and may delay proper care 3