Asthma-16

Asthma - Emergency

When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital.

• Oxygen to alleviate the hypoxia (but not the asthma itself) that results from extreme asthma attacks.
• Nebulized salbutamol or terbutaline (short-acting beta-2-agonists), often combined with ipratropium (an anticholinergic).
• Systemic steroids, oral or intravenous (prednisone, prednisolone, methylprednisolone, dexamethasone, or hydrocortisone). Some research has looked into an alternative inhaled route.
• Other bronchodilators that are occasionally effective when the usual drugs fail:
  

 (a) ... Intravenous salbutamol
 (b) Nonspecific beta-agonists, injected or inhaled (epinephrine, isoetharine, isoproterenol, metaproterenol)
 (c) ... Anticholinergics, IV or nebulized, with systemic effects (glycopyrrolate, atropine, ipratropium)
 (d) ... Methylxanthines (theophylline, aminophylline)
 (e) ... Inhalation anesthetics that have a bronchodilatory effect (isoflurane, halothane, enflurane)
 (f) ... The dissociative anaesthetic ketamine, often used in endotracheal tube induction
 (g) ... Magnesium sulfate, intravenous

• Intubation and mechanical ventilation, for patients in or approaching respiratory arrest.
• Heliox, a mixture of helium and oxygen, may be used in a hospital setting. It has a more laminar flow than ambient air and moves more easily through constricted airways.
  

All text is available under the GNU free documentation lisence
http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License

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