Therapy

• epinephrine subcutaneously ^a (0.3 ml 1:1000) 

Why?

• More patients with severe asthma who receive subcutaneous epinephrine compared with inhaled metaproterenol improve after one hour (increase in PEFR > 20%), but side-effects (palpitations, tremor, tachycardia, arrhythmia, nervousness) are common. ^a

Epinephrine helps improve PEFR in severe cases

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
acute severe asthma a	subcutaneous epinephrine	no therapy	no PEFR improvement at 60 minutes	39%	72% (34% to 88%)	4 (2 to 9)
			side-effects at 60 minutes	72%	-24% (-52% to 1%)	-6 (-60 to -3)