The American Academy of Allergy, Asthma & Immunology reports that asthma has affected approximately 34 million Americans and is responsible for over 200,000 emergency room visits and over 3,000 deaths each year. Asthma is generally considered to be a chronic lung condition caused by inflammation in the lungs resulting in breathing difficulties, but a sudden, acute asthma attack may warrant treatment in an emergency room (ER) with one of a number of rescue medications, as it can be life threatening.
Short-acting Beta-2 Agonist
Emergency room treatment of an asthma attack may involve inhalation of bronchodilators through a nebulizer machine. Bronchodilators work to relax muscles surrounding bronchial tissue to allow for better breathing. Albuterol is the most commonly used short-acting beta-2 agonist (SABAs) given by nebulizer for the treatment of an asthma attack, however it along with other SABAs including levalbuterol, metaproteronol and pirbuterol may be given by an inhaler. Albuterol is also available in oral formulations which are generally used for chronic asthma or for respiratory infections in children such as croup. Side effects commonly seen include increased heart rate and nervousness.
Anticholinergic
Ipratropium is often combined with nebulized albuterol in the treatment of an acute asthma attack in the emergency room. It works through anticholinergic activity to stop spasms of the muscles surrounding lung tissue. Ipratropium is also available as an inhaler for the treatment of acute asthma but is usually given for chronic bronchitis or emphysema. Ipratropium may cause dry mouth and nose, sore throat, headache and nervousness.
Injectable Steroid
Asthma is an inflammatory disease. Consequently, in an acute attack corticosteroids may be given through intravenous (IV) injection to immediately begin reducing inflammatory processes. Methylprednisolone and hydrocortisone are both available for IV use in the treatment of a severe asthma attack. Some patients with less severe attacks may be given oral corticosteroids such as prednisone, prednisolone or methylprednisolone.
Injectable Beta Agonist
Patients who have not responded to inhalation treatments or who are in extreme danger of death from lack of oxygen may be treated with injection of adrenergic medications, including epinephrine or terbutaline. Some patients may be given subcutaneous injection, however extreme cases may warrant the use of IV injection. Adrenergic medications, particularly those given by injection may cause increased heart rate, increased blood pressure and extreme anxiety.
Oxygen
Oxygen, administered through a breathing mask, will be needed for most patients being treated for an asthma attack in the emergency room. The Merck Manual of Medical Information states that as asthma restricts the ability to breathe, blood oxygen levels will fall. A pulse oxymeter will most likely be placed on the finger or earlobe to detect blood oxygen concentration levels that warrant treatment with oxygen. Administration of oxygen will not stop the attack but will provide higher levels of oxygen to the blood and may help to prevent death from an asthma attack.
