COPD: chronic obstructive pulmonary disease; FABA: fast-acting beta-agonist (eg, albuterol, albuterol-budesonide, albuterol-beclomethasone, or formoterol-inhaled glucocorticoid combination inhaler); GC: glucocorticoid; ICU: intensive care unit; MDI: metered dose inhaler; PaCO2: carbon dioxide tension; PEF: peak expiratory flow; SABA: short-acting beta-agonist (eg, albuterol); SpO2: pulse oxygen saturation.
* Titrate oxygen to SpO2 93 to 95% for patients with severe exacerbations, particularly if at risk for hypercapnia. Aim for SpO2 >95% in pregnant patients. Titrate to SpO2 88 to 92%, if asthma-COPD overlap.
¶ Magnesium sulfate is 4.06 mmol/g (2 g = 8.1 mmol).
Δ Please refer to the UpToDate topic on treatment of asthma exacerbations in adults.
◊ Adding ipratropium to albuterol nebulizer treatments is preferred for patients with severe exacerbations; alternatively, SABA/ipratropium can be given via MDI four to eight inhalations every 20 minutes, as needed for up to three hours.
§ The dose and duration of therapy can be modified based on the patient's past history of response, severity of exacerbation, and response to current treatment.