Emergency treatment of a client in status asthmaticus includes which of the following medications?
A. Inhaled beta-adrenergic agents
B. Inhaled corticosteroids
C. I.V. beta-adrenergic agents
D. Oral corticosteroids
Correct Answer: A. Inhaled beta-adrenergic agents
Inhaled beta-adrenergic agents help promote bronchodilation, which improves oxygenation. Albuterol is preferred over metaproterenol in that class because of its higher beta 2 selectivities and longer duration of action. The dose-response curve and duration of action of these medications are adversely affected by a combination of patient factors, including pre-existing bronchoconstriction, airway inflammation, mucus plugging, poor patient effort, and coordination.
Option B: Inhaled corticosteroids have potent glucocorticoid activity and work directly at the cellular level by reversing capillary permeability and lysosomal stabilization to reduce inflammation. The onset of action is gradual and may take anywhere from several days to several weeks for maximal benefit with consistent use. Metabolism is through the hepatic route, with a half-life elimination of up to 24 hours.
Option C: I.V. beta-adrenergic agents can be used but have to be monitored because of their greater systemic effects. They’re typically used when the inhaled beta-adrenergic agents don’t work. Intravenous beta-agonists are not routinely recommended, although there are reports of center-specific use in younger patients with status asthmaticus, nonresponsive to inhaled therapy demonstrating persistent severe hyperinflation of airways.
Option D: Corticosteroids are slow-acting, so their use won’t reduce hypoxia in the acute phase. At a physiologic level, steroids reduce airway inflammation and mucus production and potentiate beta-agonist activity in smooth muscles and reduce beta-agonists tachyphylaxis in patients with severe asthma.
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