An asthma attack, also called status asthmaticus, is an acute condition requiring immediate medical attention. Symptoms during an asthma attack include the rapidly declining ability to take a breath, a dry cough, severe wheezing and chest tightness. Medical intervention includes rescue medications to treat bronchoconstriction and inflammation. Supplemental oxygen, and in some instances, heliox, will also be given.
Bronchodilators
Bronchodilators are the first line of treatment during an asthma attack. Typically albuterol, a beta-2 agonist, is given by hand-held nebulizer, either continually or by frequent treatments, spaced five to 15 minutes apart. Instead of using a nebulizer, four puffs of albuterol can be given with a metered dose inhaler, or MDI, at 15- to 30-minute intervals. Because of fewer cardiac side effects, levalbuterol can be given in place of albuterol.
Ipratropium Bromide
Ipratropium bromide, also called Atrovent, can be used in combination with albuterol and administered either by nebulizer or MDI, every four to six hours. A DuoNeb contains albuterol and ipratropium bromide and has a five minute onset of action for the albuterol and a 20-minute onset of action for the ipratropium bromide. This mixture can also be administered by using a Combivent MDI.
Corticosteroids
Steroids are also the first line of treatment for status asthmaticus, either orally or intravenously. Dexamethasone is often given because of a longer duration of action and the necessity of fewer doses. Orally administered prednisone and prednisolone can also be given. Based on facility and physician peference, nebulized budesonide with prednisone can also be used, but it is controversial and not proven as a first-line drug.
Aminophylline
Intravenous aminophylline use is by physician and facility preference, as it has been somewhat controversial as to its effectiveness during status asthmaticus. Aminophylline is sometimes given when a patient fails to respond to bronchodilators, corticosteroids, oxygen and other treatments. A patient's theophylline level must be monitored to avoid unwanted side effects such as seizures, anxiety, nausea and arrhythmia.
Oxygen
Oxygen administration is also a critical component when treating status asthmaticus, and similar to a drug, monitoring a patient's oxygen level is essential. An arterial blood gas may be ordered to determine a patient's acid-base status, which helps the physician to ascertain the patient's likelihood of further deterioration. Oxygen can be given by nasal cannula or mask, and a patient's oxygen saturation can be monitored by pulse oximetry. Heliox, a combination of helium and oxygen, is sometimes given to relieve dyspnea, or shortness of breath. Helium creates less resistance in the airway than oxygen because of its low density; and because helium is an inert gas, there are no side effects.
References
- U.S. National Library of Medicine's Daily Med: Accuneb (Albuterol Sulfate) Solution
- U.S. National Library of Medicine's Daily Med: DuoNeb (Ipratropium Bromide and Albuterol Sulfate) Solution
- U.S. National Library of Medicine's Daily Med: Decadron (Dexamethasone) Tablet
- U.S. National Library of Medicine's Daily Med: Aminophylline (Aminophylline) Injection, Solution
- U.S. National Library of Medicine's Daily Med: Quibron T/sr (Theophylline, Anhydrous) Tablet
