Asthma - Treatment in Emergency Room

  • Initial assessment- brief physical exam, Peak Expiratory flow (PEF) or Forced Expiratory Volume in 1 second (FEV1)    

FEV1 or PEF >40% (Mild to Moderate)

  • Oxygen to keep SpO2 >90%
  • Short acting beta-2 –agonist (SABA) by Jet Nebulizer or Meter Dose Inhaler (MDI) with holding chamber x 3 doses in first hour 
  • 2.5 to 5 mg nebulized
  • 2-4 puffs MDI
  • Oral systemic corticosteroids (2mg/kg)    

FEV1 or PEF <40% (Severe)

  • Oxygen to keep SpO2 >90%
  • High dose SABA by nebulizer every 20 minutes or continuously for 1hour
  • With the addition of Ipratropium bromide 
  • 5mg to20 mg nebulized SABA with 0.5 mg Ipratropium Bromide
  • 6-8 puffs with holding chamber
  • Oral systemic corticosteroids (2mg/kg)  

Impending or actual Respiratory arrest

  • Intubation and mechanical ventilation
  • Oxygen with 100%
  • Nebulized SABA and Ipratropium bromide
  • Intravenous corticosteroids
  • Consider adjunct therapies

SABA- Albuterol, Pitbuterol,Levalbuterol

The information provided is intended as a resource only not medical advice. 

Reference article: National Asthma Education and Prevention Program Expert panel 3 “ Guidelines for the diagnosis and management of asthma” 2007