Asthma exacerbations: Key points from the NIH guidelines

Prompt assessment and aggressive treatment are crucial to effectively managing asthma exacerbations. At home, the patient should quickly assess his or her status and take a β₂-agonist, 4 puffs by metered-dose inhaler every 20 minutes or a single nebulizer dose. If 1 hour later peak expiratory flow is less than 50% of baseline, the patient should add an oral corticosteroid to his regimen and immediately call you or go to the emergency department (ED). The primary therapies for an exacerbation in the ED, clinic, and hospital are oxygen supplementation, inhaled β₂-agonists, and systemic corticosteroids. Frequent reassessments and careful modifications of treatment minimize the risk of respiratory failure and the need for hospitalization.