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Table 3 Pharmacologic management in the emergency department

From: Clinical review: Severe asthma

Agent Dose
Salbutamol (albuterol) 2.5 mg (0.5 ml) in 2.5 ml normal saline by nebulisation continuously, or every 15–20 min until a significant clinical response is achieved or serious side effects appear
Epinephrine 0.3–0.4 ml of a 1:1000 solution subcutaneously every 20 min for 3 doses
Terbutaline Preferable to epinephrine in pregnancy
β-agonists Intravenous administration should be considered in patients who have not responded to inhaled or subcutaneous treatment, in whom respiratory arrest is imminent
Corticosteroids Methylprednisolone 60–125 mg (intravenous) or prednisone 40 mg (oral)
Anticholinergics Ipratropium bromide 0.5 mg by nebulisation every 1–4 hours, combined with salbutamol
Methylxanthines Theophylline 5 mg/kg (intravenous) over 30 min – loading dose in patients not already on theophylline, followed by 0.4 mg/kg/hour intravenous maintenance dose. Serum levels should be checked within 6 hours