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Acute asthma
1Department of Emergency Medicine, Eastern Virginia Graduate School of Medicine, Norfolk, Virginia, USA.
Emergency Medicine Clinics of North America
|February 1, 1996
Summary
Severe acute asthma exacerbations require prompt, aggressive treatment, including inhaled beta-adrenergic agents and corticosteroids. Early objective pulmonary function testing guides admission decisions to reduce patient morbidity and mortality.
Area of Science:
- Pulmonology
- Emergency Medicine
- Critical Care
Background:
- Increasing emergency department visits for severe acute asthma exacerbations.
- Acute asthma requires prompt and aggressive therapeutic interventions.
Purpose of the Study:
- To outline optimal management strategies for severe acute asthma exacerbations.
- To emphasize the importance of early, aggressive treatment and objective assessment.
Main Methods:
- Directed history and physical examination concurrent with treatment.
- Administration of inhaled beta-adrenergic agents and corticosteroids.
- Consideration of anticholinergic agents for selected patients.
- Controlled endotracheal intubation with sedation and paralysis when necessary.
- Mechanical ventilation with controlled hypoventilation to decrease auto-PEEP.
- Admission decisions based on objective pulmonary function testing.
Main Results:
- Prompt therapy with inhaled beta-adrenergic agents and corticosteroids reverses most asthma attacks.
- Controlled intubation and mechanical ventilation strategies minimize associated morbidity.
- Inadequate treatment can lead to a rapidly fatal outcome.
Conclusions:
- Aggressive, timely management is crucial for severe acute asthma exacerbations.
- Objective pulmonary function testing is vital for appropriate patient disposition.
- Conservative admission strategies based on objective data reduce morbidity and mortality.