The first line of therapy is bronchodilator treatment with a beta2-agonist, typically albuterol. Handheld nebulizer treatments may be administered either continuously (10-15 mg/h) or by frequent timing (eg, every 5-20 min), depending on the severity of the bronchospasm. The dose of albuterol for intermittent dosing is 0.3-0.5 mL of a 0.5% formulation mixed with 2.5 mL of normal saline. Many of these preparations are available in a premixed form with a concentration of 0.083%. Studies have also demonstrated an excellent response to the well-supervised use of albuterol via a metered-dose inhaler with a chamber. The dose is 4 puffs, repeated at 15- to 30-minute intervals as needed. Most patients respond within 1 hour of treatment.
Leukotriene modifiers are useful for treating chronic asthma but not acute asthma. This treatment may be beneficial if used via a nebulizer, but it remains experimental.
Exercise caution in patients with other complicating factors (eg, congestive heart failure, history of cardiac arrhythmia). Intravenous isoproterenol is not recommended for the treatment of asthma because of the risk for myocardial toxicity.
Placement of an indwelling arterial catheter may be considered for blood gas sampling and continuous blood pressure measurement in patients with mechanical ventilation but is not generally recommended. The arterial waveform can also be used for measurement of pulsus paradoxus.
For more on the treatment of status asthmaticus, read here.
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Cite this: Zab Mosenifar. Fast Five Quiz: Are You Familiar With Key Components of Status Asthmaticus? - Medscape - Apr 23, 2018.
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