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Image from NIAID.


  • 24.6 Million people in US.
  • 7.8% of the population
  • Most prevalent in ages 5-19 yrs.
  • 3,600 deaths per year.


  • Reactive airway disease in which the smooth muscles lining the bronchi and bronchioles contract.
  • Attacks generally triggered by a substance (dust, pollen, smoke, exercise, cold) and which irritates the smooth muscle via an immune response.
  • The resulting bronchoconstriction, and excess mucous production makes air movement difficult causing air trapping and increased pressure inside the lungs.
  • Breathing becomes difficult and potentially life threatening.


  • See: Asthma Algorithm
  • Treatment focuses on reversing the bronchospasm.
  • First Line Medications
    • Albuterol – Selective Beta-2 agonist which causes bronchiodilation. DOSE: 2.5mg to 5mg nebulized.
    • Ipratropium Bromide – Anticholinergic which induces bronchodilation and dries up secretions in the respiratory tract. DOSE: 0.5mg nebulized.
      • Usually given with albuterol for the first 2 or three doses and then one dose every 20 minutes after that as needed.
    • Dexamethasone DOSE: 12mg IV/IOIM OR Methylprednisolone DOSE: 125mg IV/IO/IM – Steroids which act as anti-inflammatory agents and mitigate the immune response.
      • Dexamethasone preferred for its quicker onset of action and non-hypertensive properties as compared to Methylprednisolone.
  • For Severe Presentations
    • Epinephrine 1:1,000 – Alpha and Beta Agonist causing bronchodilation and reduces inflammation in the airways. DOSE: 0.3-0.6mg IM.
    • Non-Invasive Ventilation – BiPAP or CPAP. DOSE: Low PEEP (3cm H2O) with stronger IPAP (8cm H2O) if available. Increases air movement and helps drive nebulized medications into the lower airways where they are needed.
      • BiPAP is greatly preferred but CPAP can be considered with nebulized medications. Watch patient for signs of exhaustion or respiratory failure.
    • Ketamine – Anesthetic with bronchodilatory properties. DOSE: 1.5mg/kg IV OR 5mg/kg IM.
      • Studies on this are varied but can be used in attempts to stave off respiratory failure and to facilitate the use of non-invasive ventilation.
      • Induction agent of choice for Intubating asthmatics.
    • Magnesium Sulfate – Electrolyte which may increase bronchodilation. DOSE: 2gm in 100cc NS over 10 min IV/IO.
      • Studies vary on this but the drug appears to be safe to use and may be beneficial in severe cases when nothing else has worked.
  • Intubation of the Asthmatic
    • Treatments should be given aggressively in hopes of staving off the need for intubation.
    • Indications: Respiratory fatigue/failure; cardiac arrest.
    • Tips: Maximize pre-oxygenation; use largest ET Tube possible; Do not ventilation aggressively watch for breath stacking.
    • Meds:
      • Ketamine 2mg/kg AND
      • Rocuronium 1.2mg/kg OR Succinylcholine 2mg/kg
Cite this article as: Scott Kostolni, EMT-P, "Asthma," from SickPatient.com, November 2, 2017, date accessed: March 20, 2018 http://sickpatient.com/asthma/

References and Resources

  1.  Asthma. (2017, June 07). Retrieved November 01, 2017, from https://www.cdc.gov/asthma/most_recent_data.htm
  2. /u/MedicMoment. (2017, September). Medic Moment Asthma/COPD • r/ems. Retrieved November 01, 2017, from https://www.reddit.com/r/ems/comments/71neji/medic_moment_asthmacopd/
  3. Laing, S., Fenwick, R., & Yates, J. (2017, September). The Resus Room Podcast: Asthma Roadside To Resus. Retrieved November 02, 2017, from http://theresusroom.co.uk/asthma
  4. Swaminathan, A., MD, MPH. (2015, September 30). Life-Threatening Asthma. Retrieved November 02, 2017, from https://coreem.net/core/life-threatening-asthma/
  5. Scott Weingart. EMCrit Podcast 15 – the Severe Asthmatic. EMCrit Blog. Published on December 8, 2009. Accessed on November 1st 2017. Available at [https://emcrit.org/emcrit/severe-asthmatic/ ].
  6. Rezaie, S. (2015, May 28). REBELCast: The Crashing Asthmatic. Retrieved November 02, 2017, from http://rebelem.com/rebelcast-crashing-asthmatic
  7. Featured Image: NIAID. (n.d.). Asthma Inhaler [Photograph found in Asthma]. Retrieved November 2, 2017, from https://www.flickr.com/photos/niaid/5950870440/in/album-72157627224678834/ (Originally photographed 2011, July 18)

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