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Standard medications for acute asthma treatment include short-acting
β-agonists (SABAs), anticholinergics, and systemic corticosteroids.
Children with severe exacerbations should receive high-dose SABA
and ipratropium bromide in addition to prompt (within 1 hour of arrival)
systemic corticosteroids. Such patients often require frequent, possibly
continuous, SABA as well, following initial treatments.
Intravenous (IV) magnesium sulfate should be considered early in the
ED course for patients with severe exacerbations, and those not
improving after multiple inhaled bronchodilator treatments.
Emergency physicians should consider prescribing inhaled
corticosteroids (ICSs) based on the degree of asthma control.

Current Evidence
Asthma is a chronic inflammatory disease of the lower airways characterized by
bronchial hyperresponsiveness and reversible bronchospasm. While there is
common pathophysiology for patients with asthma, the phenotype is rather
heterogeneous, likely due to many interacting factors including the level of
airway inflammation, degree of bronchial hyperresponsiveness, environmental
exposures, and genetic differences (which may account for 60% to 80% of
interindividual variance in treatment response).
The National Asthma Education and Prevention Program (NAEPP) has
published guidelines outlining diagnosis and management of acute and chronic
asthma. Many institutions have implemented local acute asthma clinical practice
guidelines, which are associated with improved quality outcomes including
shorter time to medication administration, shorter length of stay (LOS), and fewer
medication prescription errors.

Goals of Treatment
Acute asthma management is directed at improving symptoms by reversing
bronchospasm and treating the underlying airway inflammation. Goals of
treatment include prompt administration of bronchodilators and systemic

corticosteroids and identification of complications.

Clinical Considerations
Clinical Recognition
Asthma is characterized clinically by a pattern of periodic episodes of cough,
wheeze, respiratory distress, and reversible bronchospasm. While wheezing is the