Usually, bronchial asthma can be controlled, if the patient has a good compliance with medications and lifestyle changes. However, some patients with asthma can develop acute exacerbations (attacks).
Oxygen therapy
Supplementary oxygen should be given to all patients with acute bronchial asthma and low blood oxygen level or saturation (low SpO2). SpO2 level should be managed between 94 % and 98 %. If there is no pulse oximetry to monitor SpO2 level, all patients with acute bronchial asthma should be given supplementary oxygen.
A nebulised β2 agonist bronchodilator (medication used to dilate airways) such as Salbutamol should be driven by oxygen flow in primary care, hospital, and ambulance. If supplementary oxygen is not available, nebulised medication is given without oxygen.
β2 agonist bronchodilators
A group of medications known as β2 agonists dilates the airways and facilitate the airflow through them. They should be used in high doses as first-line medications in acute bronchial asthma as early as possible. Oxygen driven nebulised β2 agonists like Salbutamol are recommended in life-threatening bronchial asthma. An intravenous (IV) β2 agonist, such as Salbutamol or Terbutaline, is offered for those people in whom inhaled treatment cannot be used reliably. If severe bronchial asthma is poorly responsive to an initial bolus dose of β2 agonist, think about continuous nebulisation.
Ipratropium bromide
Nebulised Ipratropium bromide (an antimuscarinic bronchodilator) is added to β2 agonist therapy for patients with acute severe or life-threatening bronchial asthma, or those with a poor initial response to β2 agonists. It helps dilate the constricted airways. The usual dose is 0.5 mg 4-6 hourly.
Steroids
Steroids inhibit the process of inflammation. Therefore, they help dilate the airways and reduce secretions in the lungs. Usually, steroids are given to all patients with acute bronchial asthma. Physicians offer oral Prednisolone 40-50 mg daily for at least five days or until recovery.
Other medications
A single dose of intravenous (IV) Magnesium sulphate can be given for patients with near fatal or life-threatening asthma, or those with acute severe asthma and a poor initial response to inhaled bronchodilator treatment. IV infusion of magnesium sulphate 1.2-2 g is given over 20 minutes. It should only be offered following consultation with a senior physician.
Antibiotics
Routine use of antibiotics is not recommended for patients with acute bronchial asthma. However, if there is a bacterial infection associated with the acute asthma attack, antibiotics can be offered.
Intensive care
If the patient with acute severe asthma has one of the following features, intensive care is indicated.
- Requiring mechanical (artificial) ventilation
- Acute severe or life-threatening bronchial asthma with a poor response to treatments, confirmed by:
- Drowsiness
- Confusion
- Altered consciousness
- Arterial blood gas (ABG) analysis expressing low pH or high H+ (hydrogen) ion level (acidity in the blood)
- Physical exhaustion, weak respiratory effort
- Respiratory arrest
- High carbon dioxide (CO2) in the blood (Hypercapnia)
- Falling PEF value
- Worsening or persistent low oxygen in the blood (hypoxia)
Related Links:
How to Diagnose Bronchial Asthma in Adults?
Prevention of Bronchial Asthma
Basics of Pharmacological Management of Asthma
Bronchial Asthma: Stepwise Management in Adults
How to Diagnose Acute Asthma in Adults?
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