Management of Acute Asthma Exacerbation
Systemic Corticosteroid Indication
- The American College of Cardiology recommends systemic corticosteroids as the only proven treatment for the inflammatory component of acute asthma exacerbations and should be administered early 1, 2
- Systemic corticosteroids should be administered early because anti-inflammatory effects may not be apparent for 6-12 hours, and early use hastens resolution of airflow obstruction and may reduce hospital admission 1, 2
Dosing for Acute Exacerbation
- For moderate exacerbations (PEF 50-75% predicted), the British Medical Journal suggests administering 30-60 mg oral prednisolone or equivalent methylprednisolone 4, 5
- For severe exacerbations (PEF <50% predicted or inability to complete sentences), the American Heart Association recommends administering 40-80 mg methylprednisolone IV or IM, or 125 mg IV (dose range 40-250 mg) 1, 2
Antibiotic Use in Acute Asthma
- The Journal of Allergy and Clinical Immunology states that antibiotics are NOT generally recommended for acute asthma exacerbations 3, 10
- Antibiotics should be reserved for cases with strong evidence of coexistent bacterial infection, such as bacterial pneumonia, bacterial sinusitis, or positive sputum bacterial cultures 3, 10, 11
Concurrent Treatment Requirements
- The American College of Cardiology recommends inhaled short-acting β2-agonists (albuterol 2.5-5 mg or salbutamol 5 mg nebulized every 20 minutes for 3 doses, then every 1-4 hours as needed) as essential adjunctive therapy 1, 2, 9
- Oxygen supplementation should be provided to maintain adequate saturation, and ipratropium bromide (0.5 mg nebulized) added to β-agonists for severe exacerbations reduces hospitalizations 1, 2, 3, 9