The evaluation and management of acute, severe asthma

This article provides a systematic approach to the patient with acute, severe asthma. After a brief, focused evaluation prompt treatment with inhaled beta 2-agonists and systemic corticosteroids remains the cornerstone of treatment. Ipratropium bromide is now recognized as a useful addition for both adult and pediatric populations, whereas consideration of intravenous MgSO4 and theophylline is warranted for refractory patients. Ongoing evaluation of antileukotriene agents offers a possibility of these agents as alternative bronchodilators. Further research with a number of potential acute asthma agents will further expand treatment options for rapid symptomatic airway improvement and prevention of progressing airway obstruction, hospitalization, and potential respiratory failure.