Don’t forget about dexamethasone as a treatment option
in your bronchoconstriction medical directive

  • Dexamethasone is a steroid utilized for its potent anti-inflammatory effect & long duration of action
  • Benefits of administering dexamethasone:
In Acute Asthma Exacerbations In COPD Exacerbations
  • Reduced # of admissions
  • Reduced # of relapses to ED
  • Reduced # of admissions
  • Reduced # of relapses to ED
  • Reduced treatment failure
  • Earlier improvement in lung function and symptoms
  • Reduced duration of assisted ventilations
  • Reduced length of stay for non-ICU patients by 1.4 days

Dexamethasone for Bronchoconstriction

  • Dexamethasone is indicated for patients with respiratory distress AND suspected bronchoconstriction AND history of asthma/COPD/20 pack-year history of smoking
  • Dexamethasone can be used in conjunction with salbutamol, epinephrine, and CPAP
  • Salbutamol, epinephrine, & CPAP are still priority treatments
  • PO is the preferred route of administration
  • Dexamethasone should be utilized even if your patient shows improvement after salbutamol or epinephrine
  • Dexamethasone’s effect will not be seen by paramedics
  • The contraindication to steroids applies to systemic steroids (PO or parenteral) NOT inhaled or topical steroids


Called Code 4 to a park for a 23 year old male complaining of SOB. On arrival you are directed to your patient and acquire the following information:


General Impression Sitting upright, learning forward. Moderate respiratory distress
Head/Neck Unremarkable
Chest Wheeze bilateral apex to base
Abdomen Unremarkable
Extremities Good radial pulses, cap refill < 2 seconds


LOC Unaltered
RR 32
SpO2 92%
HR 116
BP 138/92
Temp 37.5

Patient Information

History Asthma
Medications Flovent, salbutamol
Allergies None

Patient reports relief of dyspnea after 800mcg of salbutamol. What are the next steps in treatment?

A) Transport code 4 CTAS 2 and continue to monitor

B) Administer another 800mcg salbutamol 5-15 minutes PRN

C) Administer 8mg dexamethasone PO