There is evidence that high-flow
oxygen can be associated with hypercarbia, and that full humidification of the inspired
gases should be recommended. On the contrary, there is a lack of evidence to support the role of
heliox in the initial treatment of acute
asthma. Specific short-acting inhaled beta(2)-agonists are the drugs of choice. A more rapid and profound bronchodilatation with fewer side effects and less time of treatment can be achieved when sufficient doses are given using pressurized meter dose
inhalers and large-volume valved-spacers, particularly in patients with the most severe obstruction. Findings argue against the routine use of continuous nebulization. High and repetitive doses of
ipratropium bromide in combination with beta(2)-agonists are indicated as first line treatment of severe acute
asthma. There is insufficient evidence that inhaled
corticosteroids alone are as effective as systemic
corticosteroids. Finally, the combination of nebulized
magnesium and
albuterol provides no benefit in addition to that provided by
therapy with
albuterol in patients with mild-to-moderate
asthma exacerbations.
SUMMARY: According to the latest evidence, the goals of treatment may be summarized as follows: maintenance of adequate arterial oxygen saturation with supplemental
oxygen, relief of airflow obstruction by administration of inhaled beta-agonists and
anticholinergics, and reduction of airway
inflammation and prevention of future relapses by using early administration of systemic
corticosteroids.