Initial treatment details of asthma

• Oxygen to keep SaO2 ≥93–95%

• Inhaled SABA (eg, albuterol) by MDI (4–8 puffs) or nebulizer (2.5–5 mg) q20min

• Corticosteroids: prednisone 40–60 mg PO if outPt; methylpred IV if ED or inPt

• Ipratropium MDI (4–6 puffs) or nebulizer (0.5 mg) q20min if severe (Chest 2002;121:1977)

• Reassess after 60–90 min of Rx

Mild–mod exacerbation: cont SABA q1h

Sev exacerbation: SABA & ipratropium q1h or cont.; if refractory, consider Mg ± heliox

• Decide disposition within 4 h of presentation and after 1–3 h of Rx

• High-dose steroids: methylpred 125 mg IV q6h (NEJM 1999;340:1941)