Update on Acute Asthma

Abstract

There have been several important changes in the updated NIH asthma guidelines regarding the management of acute asthma. At home during an exacerbation, doubling the dose of inhaled corticosteroids is not recommended. Pre-hospital, a standing order for albuterol is important in implementation of protocols such as the CDC model protocol. There are new cut points of 40% and 70% predicted peak expiratory flow rates. When someone presents to the emergency department with a flow rate less than 40% predicted (approximately 200 L/min for typical adult woman and 250 L/min for typical adult man), there are several adjunct treatments that merit consideration, such as heliox and intravenous magnesium sulfate. Consider initiating inhaled corticosteroids at discharge from the emergency department. Inhaled anticholinergics can be used in the first hours of presentation to the emergency department, but are not recommended during inpatient hospitalization.

Keywords:

• Acute asthma
• exacerbation
• emergency department
• guideline
• heliox
• intravenous magnesium sulfate
• anticholinergic
• inhaled corticosteroid
• education