Management of acute asthma in the emergency department

Steven G. Schauer, Peter J. Cuenca, Jeremiah J. Johnson, Sasha Ramirez

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Asthma is primarily a clinical diagnosis that is made from a combination of historical features and clinical examination findings. The mainstay of asthma treatment includes short-acting beta agonist therapy (albuterol) and steroids. Handheld inhalers are sufficient for most inhaled therapy; all patients on inhalers should be provided with a spacer. The severity of asthma exacerbations is determined by 3 features: (1) clinical presentation, (2) peak expiratory flow rates, and (3) vital signs. Additional testing, such as chest x-ray and blood gas measurements, is reserved for select patients. Spirometry aids in the diagnosis of asthma and measurement of severity, but it is not always required, nor should it be solely relied upon to make disposition decisions. Inhaled ipratropium decreases hospitalization rates, and it should be routinely used. Levalbuterol provides little to no advantage over less-expensive racemic albuterol. Noninvasive positive pressure ventilation may be utilized in patients with moderate to severe exacerbations. Ketamine may be considered in severe exacerbations, but it should not be used routinely. Magnesium sulfate may be beneficial in severe asthma exacerbations, but routine use for mild to moderate exacerbations is not indicated.

Original languageEnglish (US)
Pages (from-to)1-28
Number of pages28
JournalEmergency medicine practice
Issue number6
StatePublished - Jun 1 2013
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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