[Treatment of acute asthma attack in the emergency department]

Although acute asthma is a very common cause of emergency department visits of children and adults, there is not as yet a standardized accepted treatment protocol. The aim of the present review is to describe updated information on the various medications used for the treatment of acute asthma attack in the emergency department on the basis of published controlled studies. Oxygen is the first treatment the patient needs in order to overcome hypoxemia. Beta-2 agonists should always be given with oxygen in order to prevent the decrease in oxygen saturation due to the increase of blood flow in relatively poor ventilated areas of the lung. With the exception of hypoxemic patients who also need oxygen, the administration of beta-2 agonists using metered-dose inhalers with a holding chamber was found to be as effective as administration with nebulizers, and in some studies, even more effective and safer. Oral prednisolone is the treatment of choice for the most severe asthma exacerbations, given together with oxygen and beta-2 agonists. With the exception of the most severe asthma attacks, high-dose inhaled corticosteroids are at least as effective as oral corticosteroids in controlling moderate-to-severe asthma attacks especially in children. This form of drug delivery is accompanied with less cortisol suppression. Other drugs such as: ipratropium bromide, theophyline or magnesium sulfate do not provide significant additional clinical benefit for the treatment of acute asthma attacks and should not be use routinely.