Asthma Exacerbations​

In severe asthma exacerbations, the airways may be so inflamed and narrowed that very little to no air is able to flow. ​

These patients may be in, or at an imminent risk of, respiratory failure. For these cases, we should consider Epinephrine. 

Why Epinephrine?​

• Beta-receptor agonist ​
  • Like salbutamol, it acts on beta-2 receptors to cause bronchodilation ​
  • Beta-1 receptors may be acted upon to increase HR and cardiac contractility (may be helpful in shock states)​
• Alpha-1 receptor agonist​
  • To a lesser extent, epinephrine may also constrict vascular smooth muscle (may be helpful in shock states) 

When to consider Epinephrine​

• As stated in the Clinical Considerations, Epinephrine should be prioritized first in the apneic patient (concurrently with airway and ventilatory management)​
• Epinephrine may need to be given after multiple rounds of salbutamol, where a patient is unresponsive to treatment and their condition is worsening.​
• This patient may look:​
  • Cyanotic​
  • Altered LOA​
  • Paradoxical breathing (e.g. during inhalation chest wall expands, abdomen drawn inward and vice versa) ​
  • May become bradycardic ​
  • Will require BVM

Other Considerations​

• Salbutamol should be administered via the MDI adapter while BVM ventilations are ongoing, as able​
• Provide gentle BVM ventilations at a lower rate and volume to avoid air trapping/hyperinflation

Summary

Epinephrine administration can assist those in respiratory failure from bronchoconstriction. If your patient is in extremis (requiring BVM ventilation) epinephrine is the FIRST medication to give, followed by salbutamol, as able.​

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