Inhaled bronchodilator (anticholinergic) | |
Ipratropium bromide nebulizer solution (250 micrograms/mL) |
|
Ipratropium bromide MDI with spacer (18 micrograms/puff) |
|
Systemic glucocorticoids | |
Dexamethasone |
|
Prednisone or prednisolone¶ |
|
Methylprednisolone |
|
Systemic beta2-agonistsΔ | |
Epinephrine 1 mg/mL (also labeled 1:1000) |
|
Terbutaline (1 mg/mL) |
|
Other treatment | |
Magnesium sulfate |
|
IM: intramuscular; IV: intravenous; MDI: metered-dose inhaler; SC: subcutaneous; VHC: valved holding chamber.
* Also refer to separate UpToDate topic reviews and table on recommended doses of beta agonist medications for treatment of acute asthma exacerbations in children <12 years of age.
¶ Useful formulations of prednisolone include concentrated oral liquids and orally disintegrating tablets (ODTs). For detail, refer to drug specific monograph included with UpToDate.
Δ Typically, subcutaneous or intramuscular epinephrine or terbutaline is reserved for patients who present to the emergency department with a severe exacerbation with markedly diminished aeration. Intravenous terbutaline is reserved for severely ill patients who are poorly responsive to conventional therapy. Alternative treatment options for these patients include noninvasive positive pressure ventilation and high-flow nasal cannula. Maximum doses of up to 10 micrograms/kg/minute have been described. However, in clinical practice, the maximum dose reached is limited by toxicities and is in the range of 2 to 3 micrograms/kg/minute. Systemic beta2-agonist treatment requires noninvasive cardiopulmonary monitoring, such as that available in a critical care setting. Orally administered systemic beta2-agonists are not recommended.
◊ Maximum dose of magnesium sulfate of up to 2.5 grams IV (approximately equal to 10 mmol) may be considered. Refer to UpToDate topics on emergency department management of acute asthma exacerbations in children, inpatient management of acute asthma exacerbations in children, and intensive care unit management of acute severe asthma exacerbations in children.[2]Courtesy of Richard Scarfone, MD, FAAP.
Additional data from: US Department of Health and Human Services. Expert panel report 3: Guidelines for the diagnosis and management of asthma. NIH Publication No. 07-4051. August 2007 available at https://www.ncbi.nlm.nih.gov/books/NBK7232/pdf/Bookshelf_NBK7232.pdf (accessed March 12, 2020).Do you want to add Medilib to your home screen?