In flight, how should an acute severe asthma attack be managed?

• A. Administer inhaled bronchodilator via MDI or nebulizer, provide oxygen, consider systemic steroids, and land as soon as practical
• B. Administer only oxygen and wait for landing
• C. Avoid any bronchodilators to reduce side effects
• D. Administer epinephrine injections in the cabin

Answer: (D)

When a person has an acute severe asthma attack, the primary goal is to rapidly reverse bronchoconstriction and keep oxygen levels adequate while arranging for definitive care. The most effective in-flight approach is to give a rapid-acting inhaled bronchodilator (short-acting beta-agonist) via a metered-dose inhaler with a spacer or via nebulizer, along with supplemental oxygen to maintain safe oxygenation. If the attack persists, systemic steroids are added to reduce the inflammatory response and help shorten the episode. The patient should be landed as soon as practical so they can receive formal evaluation and treatment.

Epinephrine injections are not the standard initial treatment for an acute asthma attack in flight. They carry systemic risks and are reserved for situations such as anaphylaxis or a life-threatening attack unresponsive to standard bronchodilators, where the benefits may outweigh the risks.