Treatment

Treatment

Treating an Acute Attack in the Hospital. An acute attack may require hospitalization. Laboratory tests, an electrocardiogram (ECG), and a chest x-ray are performed to determine lung function, oxygen levels, and other indications of severity or rule out other causes. Depending on the results, the following treatments may be given:

• Beta2-agonists are the standard therapy. They are typically administered with a nebulizer (a device that administers the drug in a fine spray). Studies suggest, however, that even very small children may be able to use metered-dose inhalers (MDIs), which are just as effective and more convenient than nebulizers. (Intravenous delivery is not recommended in most cases.)
• An anticholinergic drug (e.g., ipratropium) is sometimes added to improve symptoms.
• A corticosteroid (commonly called a steroid) given within the first hour helps reduce the need for hospitalization. Steroids may be administered intravenously, as a shot, or orally. Children may respond well to oral steroids.
• Oxygen is usually administered, and can be life saving in severe cases.
• Infusions of magnesium sulfate opens airways and are an important emergency treatment for adults. Its benefits for children need to be further demonstrated.
• In life-threatening situations, the patient may require mechanical ventilation.

Antibiotics are not useful for asthma attacks if there is no strong evidence of the presence of a bacterial infection. Viral infections, most often colds and flus, are more likely to trigger an asthma attack. In such cases, antibiotics do not appear to be beneficial and may have adverse effects.

Discharge and Relapse After Hospitalization. It typically takes about 3 to 4 hours to determine if a patient can be safely sent home or if they need to stay. Patients are generally discharged under the following circumstances:

• When symptoms are gone or minimal, and
• The peak expiratory flow rate is 70% or more of the predicted rate

Despite reasonable precautions, between 12% and 16% of patients relapse within 2 weeks. Receiving a steroid shot at discharge or taking an oral corticosteroid 5 to 7 days after leaving the hospital can reduce this risk significantly.