Nebulized corticosteroids

Inhaled short-acting beta 2 agonist treatment is the mainstay of office or emergency department treatment of moderate to severe asthma exacerbations. If the patient can tolerate a measurement of PEF or forced expiratory volume in one second (FEV 1 ), an initial value should be obtained and repeated to monitor treatment response. In patients with severe exacerbations, continuous beta 2 agonist administration has been shown to improve pulmonary function measurements and reduce hospital admission with no notable differences in pulse, blood pressure, or tremor. 21 The use of high-dose albuterol ( mg via nebulizer every 20 minutes for three doses) 22 and intravenous beta 2 agonists does not appear to be beneficial and is not recommended. 23

In the context that one major purpose of a staging system is to establish prognosis, attention has focused on the value of including weight (ie, body mass index [BMI]), dyspnea, and exercise capacity (ie, the 6-minute walk distance), with FEV 1 in staging COPD. 19 Indeed, the resultant index, called BODE (for BMI, obstruction, dyspnea, and exercise capacity) has been shown to better predict survival in COPD than FEV 1 alone. BODE scores of 0 to 10 (most impaired) are stratified into 4 quartiles, which discriminate mortality risk better than FEV 1 alone. Other multifactorial prognostic systems (eg, ADO [for age, dyspnea, and obstruction] and DOSE [for dyspnea, obstruction, smoking, and exercise capacity]) have also been proposed. 20,21

Nebulized corticosteroids

nebulized corticosteroids

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