Acute bronchospasm
Rapid reversible narrowing of airways in asthma, COPD, or anaphylaxis. Short-acting beta-2 agonist (salbutamol) delivered via spacer or nebuliser is first-line therapy.
ICD-10 J98.04 drugs
Also known as: Bronchospasm attack
Drugs used for this condition
- AIpratropium bromideFirst line · Short-acting muscarinic antagonist for inhalation (SAMA)Nebulised ipratropium combined with SABA (salbutamol) is the standard of care for severe asthma exacerbation and COPD exacerbation in the emergency room. GINA 2024 and GEMA 5.4 recommend adding ipratropium in severe asthma exacerbations in adults and children: it provides additional FEV1 gain and reduces hospitalisation. GOLD 2024 lists SAMA+SABA as the combination for acute COPD exacerbation.
- ASalbutamol (Albuterol)First line · Short-acting beta-2 adrenergic agonists (SABA)First-line reliever for acute bronchospasm of any cause (asthma, COPD, allergic airway edema, exercise). Dose via pMDI: 2 puffs of 100 mcg (total 200 mcg), repeatable in 20 minutes. Via nebulizer in severe exacerbation: 2.5–5 mg in 2.5 mL saline, repeat every 20 minutes for up to 3 doses. Onset 5–15 minutes.
- BMagnesium sulfateAdd-on therapy · Magnesium salt: intravenous solution and oral saline laxativeIn a severe asthma exacerbation, when nebulised salbutamol, ipratropium and a systemic corticosteroid are already in and breathing has not improved, the emergency department adds a single intravenous magnesium sulfate infusion. The 2014 Cochrane review in adults found fewer hospital admissions and better lung function in exactly that subgroup, with no difference in mild to moderate attacks. The Spanish label carries no such indication: it lists torsade de pointes, hypomagnesaemia, parenteral nutrition and eclampsia, so this use sits outside the label and belongs in hospital. The infusion runs under blood pressure monitoring: the label requires it during intravenous administration, and in a breathless patient a falling pressure is easy to miss.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit