A 42yo F is admitted for asthma exacerbation. She responds well to steroids, albuterol, and atrovent in the ED. What will you give her on the floor?
a. Albuterol, atrovent, steroid, azithro
b. Albuterol, atrovent, steroid
c. albuterol, steroid
d. albuterol, steroid, azithro
Practice guidelines recommend against antibiotics as most infections that trigger exacerbations are secondary to viral organisms, not bacterial.
The National Asthma Education and Prevention Program Expert Panel updated their guidelines in 2007. They recommend against inhaled anticholingerics in pure asthma patients during hospitalization. These agents are recommended as add-on therapy in the ER when a patient does not respond to a beta-agonist. Inhaled ipratropium should not be given as monotherapy in the ER because of it's slow onset of action. The combination of the two agents in the ER "has been shows to reduce rates of hospitalization by 25%" but no clear benefits have been shown for the combination once a patient has been admitted (Chest. 1996;110(3):611)
Article Showing Positive benefits of anticholingerics in Asthma
NEJM Review Article on Asthma
