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Asthma Exacerbation - #MEDSHED

Updated: Dec 6, 2023

Welcome to the #MEDSHED! Needing a brief, concise review of clinical pharmacotherapy and disease management? Direct links of reference to content discussed? Look no further than the #MEDSHED series based on infographics and carousel presentations!
 


 

🤧 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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