The treatment for reactive airway disease includes avoidance of factors that trigger symptoms and the administering of bronchodilators and steroidal drugs. Supplemental oxygen is also often given in combination with medicines. Cardiorespiratory monitoring and pulse oximetry are often used to monitor the patient's condition in reactive airway disease cases that involve moderate to severe respiratory distress. Other first-aid measures include beta-agonist nubulization and intevenous access.
In cases where air movement is poor and the patient's distress is severe, subcutaneous terbutaline or epinephrine might be given. When mild to moderate exacerbations of asthma are present, albuterol is often recommended for initial treatment. It is administered using either a metered-dose inhaler with a spacer, with or without a mask; or by using a handheld nebulizer.
Albuterol dosage recommendations using a metered-dose inhaler range from two to six puffs. A dosage of 2.5-5.0 milligrams is recommended when using a handheld nebulizer. As many as three nebulizer doses administered every 20 minutes are recommended. Other drugs used in the initial treatment for reactive airway disease include oral dexamethasone and oral prednisolone.
When the patient has severe exacerbations, or an exacerbation resulting from initial treatment, nebulized ipratropium bromide and short-acting beta-agonists given every 20 minutes and administered as many as three times are recommended for the treatment of children and adolescents. Younger children should receive 250 micrograms per dose, and adolescents can receive 500 micrograms in a dose. In order to maintain an oxygen saturation level of greater than 92 percent, supplemental oxygen is recommended when administering short-acting beta agonists and anticholinergics.
Cases of status asthmaticus occur when the patient does not respond to initial treatments with bronchodilators and there is an acute exacerbation of asthma. Status asthmaticus varies in its symptoms from mild to severe. This condition is often accompanied by airway inflammation, bronchospasm and mucus plugs that inhibit breathing. Other symptoms include retention of carbon dioxide, hypoxemia and, ultimately, respiratory failure. Clinical symptoms in many patients often include a severe asthma wheeze, although this is not a constant. Some patients might have symptoms of a cough, emesis or dyspnea.
The management of status asthmaticus as a treatment for reactive airway disease includes continuous inhalation of a beta-agonist, nebulized ipratropium, intravenous (IV) dexamethasone and intravenous magnesium for the child in severe respiratory distress. In severe cases, intramuscular (IM) or subcutaneous (SC) epinephrine or terbutaline might be considered. IV hydration is also recommended in severe asthmatic cases that require hospital admission.
It is critical that the patient's cardiorespiratory functions are evaluated frequently during treatment. Pulse oximetry and noninvasive end-tidal carbon dioxide monitoring are considered optimal monitoring methods. If the patient continues to be critically ill, serial blood gas measurements might be taken.
If the patient fails to improve following these treatments, he or she might be hospitalized, and noninvasive positive pressure ventilation (PPV) might be initiated. Intermittent positive airway pressure (PAP) might also be used prior to employing rapid-sequence intubation. There is a risk of pneumothorax resulting from intubation, so other therapeutic steps usually are taken first. Administering continuous albuterol nebulization might lessen the necessity for endotracheal intubation in status asthmaticus patients.
