Emergency treatment of asthma

Rapid and directed evaluation of the acutely ill patient with asthma allows for the assessment of severity of obstruction. Aggressive therapy with inhaled beta-agonists, corticosteroids, and supplemental oxygen remains the cornerstone of therapy for patients presenting to the hospital. Patients demonstrating an incomplete response to inhaled beta-agonists will require inhaled anticholinergics and may benefit from subcutaneous epinephrine or terbutaline. Theophylline should be continued in all patients who are chronically maintained on this medication and may benefit patients admitted to the hospital for a serious exacerbation. Deterioration or failure to improve despite optimal treatment identifies those patients who are likely to require mechanical ventilation and who should be closely observed in the intensive care unit.