The mainstay of emergency department therapy for acute asthma is inhaled beta2-agonists. The most effective particle sizes are 1-5 μm. Larger particles are ineffective because they are deposited in the mouth and central airways. Particles < 1 μm are too small to be effective because they move in the airways by Brownian motion and do not reach the lower airways.
Patients who respond poorly or not at all to an inhaled beta-agonist regimen may respond to parenteral beta2-agonists, such as 0.25 mg terbutaline or 0.3 mg of 1:1000 concentration of epinephrine administered subcutaneously. This treatment should be reserved for patients who are seriously ill and not responding to serial treatments with inhaled beta-agonist/anticholinergic therapy and other more established therapies.
Omalizumab is indicated for adults and children aged ≥ 6 years with moderate to severe persistent asthma who have a positive skin test result or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids. Omalizumab has been shown to reduce the number of asthma exacerbations. However, immunotherapy for the treatment of asthma should be avoided if the patient is taking beta-blockers, is having an asthma exacerbation, or has moderate or worse fixed obstruction. A major risk factor for immunotherapy-related fatalities includes uncontrolled asthma; therefore, appropriate caution should be exercised.
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Cite this: George D. Harris. Fast Five Quiz: Stress-Related Conditions - Medscape - Sep 26, 2019.