Severe asthma is a challenging topic, because this spans a lot of different patient phenotypes with varying severity and physiology. This chapter attempts to outline some general principles to guide management, but ultimately clinical judgement and serial evaluation at the bedside will trump all of this. The rarity, acuity, and heterogeneity of severe asthma make this difficult to study. Thus, there is relatively little evidence for most of the material discussed here.
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The IBCC chapter is located here.
- The podcast & comments are below.
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Josh Farkas
Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Great chapter. Thought there’s minimal evidence, I’ve started using high-dose Mg and on the really sick asthmatics. Below paper from peds lit but very interesting. Seems issue is likely that Mg moves so quickly out of serum that a single dose doesn’t do much.
I typically give 2 gm and repeat 2-3 times over 1st hour and then start an infusion at 2-4 gm/hour. Does it work? Who knows. The handful of patients I’ve used it on improved but I gave 12 other things too so hard to know
Article: High-Dose Magnesium Sulfate Infusion for
Severe Asthma in the Emergency Department:
Efficacy Study*
https://www.ncbi.nlm.nih.gov/pubmed/26649938
Great stuff!
How do you make the epinephrine solution?