Editing Asthma (section)

===Others===
Inflammation in the lungs can be estimated by the level of exhaled [[nitric oxide]].<ref name="Petsky_2016" /><ref name="Petsky_2016_2" /> The use of exhaled nitric oxide levels (FeNO) to guide asthma medication dosing may have small benefits for preventing asthma attacks but the potential benefits are not strong enough for this approach to be universally recommended as a method to guide asthma therapy in adults or children.<ref name="Petsky_2016">{{cite journal | vauthors = Petsky HL, Kew KM, Turner C, Chang AB | title = Exhaled nitric oxide levels to guide treatment for adults with asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011440 | date = September 2016 | issue = 9 | pmid = 27580628 | pmc = 6457753 | doi = 10.1002/14651858.CD011440.pub2 }}</ref><ref name="Petsky_2016_2">{{cite journal | vauthors = Petsky HL, Kew KM, Chang AB | title = Exhaled nitric oxide levels to guide treatment for children with asthma | journal = The Cochrane Database of Systematic Reviews | volume = 11 | pages = CD011439 | date = November 2016 | issue = 5 | pmid = 27825189 | pmc = 6432844 | doi = 10.1002/14651858.CD011439.pub2 }}</ref>

When asthma is unresponsive to usual medications, other options are available for both emergency management and prevention of flareups. Additional options include:
* Humidified [[oxygen]] to alleviate [[hypoxia (medical)|hypoxia]] if [[oxygen saturation|saturations]] fall below 92%.<ref name="BertrandSánchez2020" />
* Corticosteroids by mouth, with five days of [[prednisone]] being the same two days of [[dexamethasone]].<ref>{{cite journal | vauthors = Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL | display-authors = 6 | title = Dexamethasone for acute asthma exacerbations in children: a meta-analysis | journal = Pediatrics | volume = 133 | issue = 3 | pages = 493–9 | date = March 2014 | pmid = 24515516 | pmc = 3934336 | doi = 10.1542/peds.2013-2273 }}</ref> One review recommended a seven-day course of steroids.<ref>{{cite journal | vauthors = Rowe BH, Kirkland SW, Vandermeer B, Campbell S, Newton A, Ducharme FM, Villa-Roel C | s2cid = 30182169 | title = Prioritizing Systemic Corticosteroid Treatments to Mitigate Relapse in Adults With Acute Asthma: A Systematic Review and Network Meta-analysis | journal = Academic Emergency Medicine | volume = 24 | issue = 3 | pages = 371–381 | date = March 2017 | pmid = 27664401 | doi = 10.1111/acem.13107 | doi-access = free }}</ref>
* [[Magnesium sulfate]] intravenous treatment increases bronchodilation when used in addition to other treatment in moderate severe acute asthma attacks.<ref name="NHLBI07p373" /><ref>{{cite journal | vauthors = Noppen M | title = Magnesium treatment for asthma: where do we stand? | journal = Chest | volume = 122 | issue = 2 | pages = 396–8 | date = August 2002 | pmid = 12171805 | doi = 10.1378/chest.122.2.396 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Griffiths B, Kew KM | title = Intravenous magnesium sulfate for treating children with acute asthma in the emergency department | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011050 | date = April 2016 | issue = 4 | pmid = 27126744 | pmc = 6599814 | doi = 10.1002/14651858.CD011050.pub2 | url = http://openaccess.sgul.ac.uk/107920/1/MCG%2DAST.pdf }}</ref> In adults intravenous treatment results in a reduction of hospital admissions.<ref>{{cite journal | vauthors = Kew KM, Kirtchuk L, Michell CI | title = Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | pages = CD010909 | date = May 2014 | pmid = 24865567 | doi = 10.1002/14651858.CD010909.pub2 | pmc = 10892514 | url = http://openaccess.sgul.ac.uk/107426/1/CD010909.pdf | veditors = Kew KM }}</ref> Low levels of evidence suggest that inhaled (nebulized) magnesium sulfate may have a small benefit for treating acute asthma in adults.<ref name="Knightly_2017">{{cite journal | vauthors = Knightly R, Milan SJ, Hughes R, Knopp-Sihota JA, Rowe BH, Normansell R, Powell C | title = Inhaled magnesium sulfate in the treatment of acute asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD003898 | date = November 2017 | issue = 11 | pmid = 29182799 | pmc = 6485984 | doi = 10.1002/14651858.CD003898.pub6 }}</ref> Overall, high-quality evidence do not indicate a large benefit for combining magnesium sulfate with standard inhaled treatments for adults with asthma.<ref name="Knightly_2017" />
* [[Heliox]], a mixture of helium and oxygen, may also be considered in severe unresponsive cases.<ref name="NHLBI07p373" />
* Intravenous salbutamol is not supported by available evidence and is thus used only in extreme cases.<ref name=rodrigo>{{cite journal | vauthors = Rodrigo GJ, Rodrigo C, Hall JB | title = Acute asthma in adults: a review | journal = Chest | volume = 125 | issue = 3 | pages = 1081–102 | date = March 2004 | pmid = 15006973 | doi = 10.1378/chest.125.3.1081 }}</ref>
* [[Methylxanthines]] (such as [[theophylline]]) were once widely used, but do not add significantly to the effects of inhaled beta-agonists.<ref name=rodrigo/> Their use in acute exacerbations is controversial.<ref name="GINA_2011_page37">{{harvnb|GINA|2011|p=37}}</ref>
* The dissociative anaesthetic [[ketamine]] is theoretically useful if [[intubation]] and [[mechanical ventilation]] is needed in people who are approaching respiratory arrest; however, there is no evidence from clinical trials to support this.<ref name="NHLBI07p399">{{harvnb|NHLBI Guideline|2007|p=399}}</ref>  A 2012 Cochrane review found no significant benefit from the use of ketamine in severe acute asthma in children.<ref>{{cite journal | vauthors = Jat KR, Chawla D | title = Ketamine for management of acute exacerbations of asthma in children | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD009293 | date = November 2012 | pmid = 23152273 | pmc = 6483733 | doi = 10.1002/14651858.CD009293.pub2 | collaboration = Cochrane Airways Group }}</ref>
* For those with severe persistent asthma not controlled by inhaled corticosteroids and LABAs, [[bronchial thermoplasty]] may be an option.<ref name=Bronch10>{{cite journal | vauthors = Castro M, Musani AI, Mayse ML, Shargill NS | title = Bronchial thermoplasty: a novel technique in the treatment of severe asthma | journal = Therapeutic Advances in Respiratory Disease | volume = 4 | issue = 2 | pages = 101–16 | date = April 2010 | pmid = 20435668 | doi = 10.1177/1753465810367505 | doi-access = free }}</ref> It involves the delivery of controlled thermal energy to the airway wall during a series of [[bronchoscopy|bronchoscopies]].<ref name=Bronch10/><ref>{{cite journal | vauthors = Boulet LP, Laviolette M | title = Is there a role for bronchial thermoplasty in the treatment of asthma? | journal = Canadian Respiratory Journal | volume = 19 | issue = 3 | pages = 191–2 | date = May–Jun 2012 | pmid = 22679610 | pmc = 3418092 | doi = 10.1155/2012/853731 | doi-access = free }}</ref> While it may increase exacerbation frequency in the first few months it appears to decrease the subsequent rate.<!-- <ref name=GINA_2011_page70> --> Effects beyond one year are unknown.<ref name=GINA_2011_page70>{{harvnb|GINA|2011|p=70}}</ref>
* [[Monoclonal antibody]] injections such as [[mepolizumab]],<ref name="Mepolizumab">{{cite web|url=https://www.fda.gov/media/114447/download |title=Pulmonary-Allergy Drugs Advisory Committee Meeting|date=July 25, 2018|publisher=[[FDA]]|access-date=May 9, 2019}}</ref> [[dupilumab]],<ref name="Dupilumab">{{cite journal | vauthors = Sastre J, Dávila I | title = Dupilumab: A New Paradigm for the Treatment of Allergic Diseases | journal = Journal of Investigational Allergology & Clinical Immunology | volume = 28 | issue = 3 | pages = 139–150 | date = June 2018 | pmid = 29939132 | doi = 10.18176/jiaci.0254 | doi-access = free | hdl = 10486/686799 | hdl-access = free }}</ref> or [[omalizumab]] may be useful in those with poorly controlled atopic asthma.<ref name=NEJM2017>{{cite journal | vauthors = Israel E, Reddel HK | title = Severe and Difficult-to-Treat Asthma in Adults | journal = The New England Journal of Medicine | volume = 377 | issue = 10 | pages = 965–976 | date = September 2017 | pmid = 28877019 | doi = 10.1056/NEJMra1608969 | s2cid = 44767865 }}</ref> However, {{As of|2019|lc=y}} these medications are expensive and their use is therefore reserved for those with severe symptoms to achieve cost-effectiveness.<ref>{{cite journal | vauthors = McQueen RB, Sheehan DN, Whittington MD, van Boven JF, Campbell JD | title = Cost-Effectiveness of Biological Asthma Treatments: A Systematic Review and Recommendations for Future Economic Evaluations | journal = PharmacoEconomics | volume = 36 | issue = 8 | pages = 957–971 | date = August 2018 | pmid = 29736895 | doi = 10.1007/s40273-018-0658-x | s2cid = 13681118 }}</ref> Monoclonal antibodies targeting [[Interleukin 5|interleukin-5]] (IL-5) or its receptor (IL-5R), including [[mepolizumab]], [[reslizumab]] or [[benralizumab]], in addition to standard care in severe asthma is effective in reducing the rate of asthma exacerbations. There is limited evidence for improved health-related quality of life and lung function.<ref>{{cite journal | vauthors = Farne HA, Wilson A, Milan S, Banchoff E, Yang F, Powell CV | title = Anti-IL-5 therapies for asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 7 | pages = CD010834 | date = July 2022 | pmid = 35838542 | pmc = 9285134 | doi = 10.1002/14651858.CD010834.pub4 }}</ref>
* Evidence suggests that [[sublingual immunotherapy]] in those with both [[allergic rhinitis]] and asthma improve outcomes.<ref name="pmid23532243">{{cite journal | vauthors = Lin SY, Erekosima N, Kim JM, Ramanathan M, Suarez-Cuervo C, Chelladurai Y, Ward D, Segal JB | display-authors = 6 | title = Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review | journal = JAMA | volume = 309 | issue = 12 | pages = 1278–88 | date = March 2013 | pmid = 23532243 | doi = 10.1001/jama.2013.2049 | doi-access =  }}</ref>
* It is unclear if [[non-invasive positive pressure ventilation]] in children is of use as it has not been sufficiently studied.<ref>{{cite journal | vauthors = Korang SK, Feinberg J, Wetterslev J, Jakobsen JC | title = Non-invasive positive pressure ventilation for acute asthma in children | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD012067 | date = September 2016 | issue = 9 | pmid = 27687114 | pmc = 6457810 | doi = 10.1002/14651858.CD012067.pub2 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/39356050|date = October 2024}}