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Epinephrine and its use in acute life-threatening asthma in adults

07 October 2011
Features
02 October 2011
Volume 3 · Issue 10

Abstract

Epinephrine (adrenaline) is commonly used by paramedics in a range of clinical scenarios. Its role in cardiac arrest scenarios is well established, but the indications for use in acute severe or life-threatening asthma are less well defined. This article reviews the evidence for the use of epinephrine in acute severe asthma and uses a case study to highlight some of the potential side-effects that clinicians need to be aware of.

Epinephrine is a catecholamine produced by the adrenal glands and has actions on nearly all cell types in its role as a hormone and neurotransmitter. Epinephrine acts upon p1 and p2 adrenergic receptors. It produces the ‘fight or flight’ response; namely, increased cardiac output and bronchodilation (Bylund et al, 1994).

In lower doses, the p receptors are stimulated preferentially resulting in smooth muscle relaxation, peripheral vasodilatation and hypotension. Higher doses result in stimulation of peripheral alpha-receptors resulting in an increase in peripheral vascular resistance and elevation of blood pressure (Davis et al, 2008).

It was first artificially synthesized in 1904 by Friedrich Stolz (original paper reviewed by Brucke, 1954) and since that time has become a key tool in managing critically unwell patients. Its role in a diverse range of conditions is well documented, from respiratory problems such as croup (Bjornson et al, 2011) and anaphylaxis (Simons and Simons, 2010) to cardiac arrest victims (Morley, 2011).

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Acute severe asthma
Anaphylaxis
Epinephrine
Leukocytosis