Treatment of acute asthma Brian J Lipworth, MD  The Lancet  Volume 350, Pages S18-S23 (October 1997) DOI: 10.1016/S0140-6736(97)90032-5 Copyright © 1997 Elsevier Ltd Terms and Conditions

Figure 1 Guidelines for hospital treatment of acute severe asthma Adapted from international and UK guidelines.1, 2 Usual recommended doses In adults for acute severe asthma: nebulised salbutamol 5 mg, nebulised ipratropium 0.5 mg; oral prednisolone 50 mg, intravenous (iv) hydrocortisone 200 mg; iv salbutamol 4 μg/kg, iv aminophylline 5 mg/kg (both as infusions over 20 min). The Lancet 1997 350, S18-S23DOI: (10.1016/S0140-6736(97)90032-5) Copyright © 1997 Elsevier Ltd Terms and Conditions

Figure 2 Acute bronchodilator response (FEV1) to cumulative doses of inhaled formoterol following pretreatment with regular formoterol 24 μg twice daily (FM) or placebo (PL) given for 4 weeks Repeated puffs of formoterol (12-108 μg, shown as shaded dose-ramp) were given 1 hour after bolus administration of either systemic corticosteroid (S) or placebo. The data are shown as change from baseline (δ) in FEV1 plotted against time after the first administered puff of formoterol (time O represents 1 hour after placebo or steroid administration). This shows that prior treatment with formoterol alone (FM) induces bronchodilator subsensitivity, as a rightward shift in the dose-response curve, compared with placebo alone (PL), which is acutely reversed after 1 hour of systemic corticosteroid administration (FM+S). Adapted from Tan et al, Am J Respir Crit Care Med 1997, 54 with permission of the American Lung Association. The Lancet 1997 350, S18-S23DOI: (10.1016/S0140-6736(97)90032-5) Copyright © 1997 Elsevier Ltd Terms and Conditions