Life-threatening asthma, part 2: Strategies for management

Hilary Goldberg, Jay Peters

Research output: Contribution to journalReview articlepeer-review


β-Agonists, administered by metered-dose inhaler or nebulizer, are still the mainstay of therapy for asthma exacerbations. A trial of a subcutaneous β-agonist should be considered in patients who fail to respond to inhaled medications. Levalbuterol may play a role in managing refractory asthma, particularly in patients with ischemic heart disease or severe tachycardia. Systemic corticosteroids should be administered to all patients presenting to the hospital with asthma unless their peak expiratory flow rate (PEFR) or forced expiratory volume in 1 second (FEV 1) is at least 80% of predicted after 1 hour of treatment; this therapy should be instituted within 1 hour of presentation. For patients with severe obstruction, the combined use of an anticholinergic and a β-agonist improves PEFR and FEV 1 more than β-agonists alone and significantly decreases the risk of hospital admission.

Original languageEnglish (US)
Pages (from-to)238-249
Number of pages12
JournalJournal of Respiratory Diseases
Issue number6
StatePublished - Jun 2005

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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