Editing Asthma (section)

====Medications for asthma exacerbations====
[[File:Salbutamol2.JPG|thumb|upright|alt=A round canister above a blue plastic holder|[[Salbutamol]] metered dose inhaler commonly used to treat asthma attacks]]

* Short-acting [[Beta2-adrenergic agonist|beta<sub>2</sub>-adrenoceptor agonists]] (SABAs), such as [[salbutamol]] (''albuterol'' [[United States Adopted Name|USAN]]) are the first-line treatment for asthma symptoms.<ref name="NHLBI07p214" /> They are recommended before exercise in those with exercise-induced symptoms.<ref>{{cite journal |vauthors=Parsons JP, Hallstrand TS, Mastronarde JG, Kaminsky DA, Rundell KW, Hull JH, Storms WW, Weiler JM, Cheek FM, Wilson KC, Anderson SD |display-authors=6 |title=An Official American Thoracic Society Clinical Practice Guideline: Exercise-Induced Bronchoconstriction |journal=American Journal of Respiratory and Critical Care Medicine |volume=187 |issue=9 |pages=1016–1027 |date=May 2013 |pmid=23634861 |doi=10.1164/rccm.201303-0437ST }}</ref>
* [[Anticholinergic]] medications, such as [[ipratropium]], provide additional benefit when used in combination with SABA in those with moderate or severe symptoms and may prevent hospitalizations.<ref name="NHLBI07p214" /><ref name="Griffiths_2013">{{cite journal | vauthors = Griffiths B, Ducharme FM | title = Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD000060 | date = August 2013 | pmid = 23966133 | doi = 10.1002/14651858.CD000060.pub2 | pmc = 12047668 }}</ref><ref name="Kirkland_2017">{{cite journal | vauthors = Kirkland SW, Vandenberghe C, Voaklander B, Nikel T, Campbell S, Rowe BH | title = Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD001284 | date = January 2017 | issue = 1 | pmid = 28076656 | pmc = 6465060 | doi = 10.1002/14651858.CD001284.pub2 }}</ref> Anticholinergic bronchodilators can also be used if a person cannot tolerate a SABA.<ref name="Self, Timothy 2009" /> If a child requires admission to hospital additional ipratropium does not appear to help over a SABA.<ref>{{cite journal | vauthors = Vézina K, Chauhan BF, Ducharme FM | title = Inhaled anticholinergics and short-acting beta(2)-agonists versus short-acting beta2-agonists alone for children with acute asthma in hospital | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 7 | pages = CD010283 | date = July 2014 | pmid = 25080126 | doi = 10.1002/14651858.CD010283.pub2 | pmc = 10772940 }}</ref> For children over 2 years old with acute asthma symptoms, inhaled anticholinergic medications taken alone is safe but is not as effective as inhaled SABA or SABA combined with inhaled anticholinergic medication.<ref>{{cite journal | vauthors = Teoh L, Cates CJ, Hurwitz M, Acworth JP, van Asperen P, Chang AB | title = Anticholinergic therapy for acute asthma in children | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD003797 | date = April 2012 | pmid = 22513916 | doi = 10.1002/14651858.CD003797.pub2 | pmc = 11329281 | url = https://espace.library.uq.edu.au/view/UQ:274872/UQ274872_OA.pdf }}</ref><ref name="Griffiths_2013" /> Adults who receive combined inhaled medications, which include short-acting anticholinergics and SABA, may be at risk for increased adverse effects such as experiencing a tremor, agitation, and heart beat [[palpitations]] compared to people who are treated with SABAs alone.<ref name="Kirkland_2017" />
* Older, less selective [[adrenergic receptor|adrenergic agonists]], such as inhaled [[epinephrine (medication)|epinephrine]], have similar efficacy to SABAs.<ref name="Rodrigo">{{cite journal | vauthors = Rodrigo GJ, Nannini LJ | title = Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials | journal = The American Journal of Emergency Medicine | volume = 24 | issue = 2 | pages = 217–22 | date = March 2006 | pmid = 16490653 | doi = 10.1016/j.ajem.2005.10.008 }}</ref> They are, however, not recommended due to concerns regarding excessive cardiac stimulation.<ref name="NHLBI07p351">{{harvnb|NHLBI Guideline|2007|p=351}}</ref>
* Corticosteroids can also help with the acute phase of an exacerbation because of their antiinflammatory properties. The benefit of systemic and oral corticosteroids is well established. Inhaled or nebulized corticosteroids can also be used.<ref name="BertrandSánchez2020" /> For adults and children who are in the hospital due to acute asthma, systemic (IV) corticosteroids improve symptoms.<ref>{{cite journal | vauthors = Smith M, Iqbal S, Elliott TM, Everard M, Rowe BH | title = Corticosteroids for hospitalised children with acute asthma | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD002886 |year = 2003 | volume = 2003 | pmid = 12804441 | doi = 10.1002/14651858.CD002886 | pmc = 6999806 }}</ref><ref>{{cite journal | vauthors = Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW | title = Early emergency department treatment of acute asthma with systemic corticosteroids | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002178 |year = 2001 | pmid = 11279756 | doi = 10.1002/14651858.CD002178 | pmc = 7025797 }}</ref> A short course of corticosteroids after an acute asthma exacerbation may help prevent relapses and reduce hospitalizations.<ref>{{cite journal | vauthors = Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW | title = Corticosteroids for preventing relapse following acute exacerbations of asthma | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD000195 | date = July 2007 | pmid = 17636617 | doi = 10.1002/14651858.CD000195.pub2 | s2cid = 11992578 }}</ref>
* Other remedies, less established, are intravenous or nebulized magnesium sulfate and helium mixed with oxygen. Aminophylline could be used with caution as well.<ref name="BertrandSánchez2020" />
* Mechanical ventilation is the last resort in case of severe hypoxemia.<ref name="BertrandSánchez2020" />
* Intravenous administration of the drug [[aminophylline]] does not provide an improvement in bronchodilation when compared to standard inhaled beta<small><sub>2</sub></small> agonist treatment.<ref name=Nai2012>{{cite journal | vauthors = Nair P, Milan SJ, Rowe BH | title = Addition of intravenous aminophylline to inhaled beta(2)-agonists in adults with acute asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | pages = CD002742 | date = December 2012 | issue = 12 | pmid = 23235591 | doi = 10.1002/14651858.CD002742.pub2 | pmc = 7093892 }}</ref> Aminophylline treatment is associated with more adverse effects compared to inhaled beta<sub><small>2</small></sub> agonist treatment.<ref name=Nai2012/>