Our approach to office management of asthma exacerbations in adults and adolescents

FABA: fast-acting beta-agonist (eg, albuterol, albuterol-budesonide, albuterol-beclomethasone, or formoterol-inhaled glucocorticoid combination inhaler); GC: glucocorticoid; LABA: long-acting beta-agonist; MDI: metered dose inhaler; PEF: peak expiratory flow; SABA: short-acting beta-agonist; SpO₂: pulse oxygen saturation.

* A FABA may be used in place of a SABA as a reliever in this setting. Most clinician offices use albuterol as an acute reliever rather than other fast-acting beta agonist therapies.

¶ In a minority of patients, symptoms resolve quickly and completely with one dose of albuterol (eg, 2 to 4 inhalations or one nebulizer treatment) and PEF is ≥80% of predicted or personal best. Oral glucocorticoid is not necessary, but a step-up in controller medication may be needed.

Δ Refer to UpToDate content on asthma management or https://ginasthma.org/.

◊ Comorbid conditions that may complicate asthma exacerbation include the following:

• Acute bronchitis
• Acute bacterial sinusitis
• Heart failure; arrhythmia
• Influenza, COVID-19
• Pneumonia
• Pneumothorax
• Anaphylaxis

Suggestive symptoms include fever, myalgias, purulent sputum, chest pain, poor response to SABA. Refer to UpToDate content on diagnosis and management.

§ Individuals with PEF 60 to 70% of predicted following initial treatment can sometimes safely continue treatment at home if their symptoms are improving, they have an asthma-safe home environment, have the necessary medications and understand their proper administration, are deemed adherent to therapy, and have ready access to emergent care if needed.