Acute asthma: The basics of assessment and treatment

Patients with acute asthma who are most likely to require hospital admission or to relapse after discharge from the ED have a combination of the following: PEF of less than 50% of predicted, oxygen saturation of less than 91%, dyspnea, and lack of bronchodilator response of at least 15% improvement in forced expiratory volume in 1 second or PEF after the first therapeutic intervention. The use of low-flow oxygen is pivotal; generally, only modest enrichment of inspired oxygen is required. β2-Agonists are the bronchodilators of choice, and corticosteroids should be given to patients whose symptoms have not resolved after 60 to 90 minutes of intensive bronchodilator treatment. Consider adding ipratropium to short-acting β2-agonist therapy in patients with the severest asthma.