How should acute asthma be treated?

The aim of treating acute asthma (whether intermittent or persistent) is to relieve the airway narrowing (bronchospasm) as soon as possible and make sure that the patient is getting adequate oxygen.

  1. Nebulised or inhaled short acting bronchodilators (beta 2 agonists), e.g. salbutamol (Ventolin) or fenoterol (Berotec). Oral short acting bronchodilators are rarely used as the inhaled drugs are better and safer.
  2. Antibiotics are usually not needed.
  3. Sedatives and antihistamines must be avoided.
  4. Oral theophylline is only rarely used. Rectal and intravenous theophylline, and subcutaneous adrenaline, are dangerous and should not be used.

Acute intermittent asthma is usually mild and can be treated at home. ‘Reliever’ treatment can be given at home with inhaled short acting bronchodilators using a spacer (e.g. 1 or 2 puffs of salbutamol or fenoterol, i.e. 100–200 μg). This can be repeated after an hour if needed. The child must be carefully observed and moved to hospital if the wheeze gets worse. An inhaled short acting bronchodilator can also be taken before exercise to prevent wheezing or cough.

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