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🤧 Asthma Exacerbation - #MEDSHED
🚨 All patients presenting with an asthma exacerbation should be given oxygen to maintain O2 above 92%. Management of asthma exacerbations are similar for pregnant women
Empiric antibiotics are not recommended, most respiratory infections are viral compared to bacterial. Optimize pharmacologic management while inpatient to transition into outpatient regimen. Chest XR more to rule out other etiologies
🔍Inhaled Beta-2 agonists
Short acting beta-2 agonists bind to beta receptors in lungs, resulting in bronchodilation
Albuterol 2.5 - 5 mg nebulized every 20 minutes x 3 doses
Caution with tachycardia, transient hypokalemia
✨Inhaled anticholinergics
Short acting antimuscurinics block acetylcholine in smooth muscle, leads to bronchodilation
Ipratropium 500 mcg nebulized every 20 minutes x 3 doses
Consider giving as combination albuterol-ipratropium
😱 Corticosteroids
Refractory to aggressive bronchodilator management
Prednisone 40 - 50 mg equivalent by mouth daily
Reduces need for hospitalization and incidence of relapse
Earlier administration (< 1 hour) associated with better outcomes
🐍 Magnesium sulfate
Bronchodilator properties via Mg effects on inhibition of calcium influx into bronchial smooth muscles
MgSO4 2 gm IV over 20 minutes
May possibly decrease need for hospitalization
Routine administration questionable given available evidence
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References
Castillo JR, Peters SP, Busse WW. J Allergy Clin Immunol Pract. 2017 July-August; 5(4): 918–927.
Hockman SM, Catapano A, Shawl A, Somwaru B. Emerg Med Pract. 2022 Feb 1;24(2):1-32. Ramasahai JM, Hansbro PM, Wark PA. Am J Respir Crit Care Med. 2019 Feb 15;199(4):423-432.
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