N Engl J Med 2010; 363:2567-2569, December 23, 2010
In the article by Lazarus (Aug. 19 issue),1 the author provides a comprehensive and balanced review of the emergency treatment of asthma but does not discuss the controversy around the use of epinephrine for acute severe asthma exacerbations.2
The National Asthma Education and Prevention Program guidelines3 restrict the use of subcutaneous epinephrine to the prehospital setting whenever nebulized short-acting β2-adrenergic agonists are not available. Nonetheless, some authors propose its use as a last chance to avoid intubation.4
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