Asthma Exacerbations consist of acute or sub-acute episodes of progressively worsening breathlessness, coughing, wheezing and chest tightness or any combination of these.
These differ from episodes of poor asthma control in the diurnal variability of airflow; a key marker of poor asthma control may not change during an exacerbation.
A major advancement in the new guidelines of the National Asthma Education and Prevention Program (NAEPP) (EPR3) (1) is the creation of a chapter on asthma exacerbations management.
In addition to this, the new guidelines presents different spirometry cut points for assessing the severity of acute asthma (exacerbations) against chronic asthma. These and other changes underscore the distinction between managing acute and chronic asthma.
Early treatment of asthma exacerbations is the best strategy for treatment.
Important elements of early treatment at the patient’s home, should include:
- A written action plan for the asthma exacerbation itself
- Recognition of the first signs and symptoms of it getting worse
- Intensification of appropriate therapy by increasing ß-agonists
- The short duration of action
- The addition of a short duration of oral corticosteroids
- Removal or the pulling away from an environmental factor that contributes to exacerbation
- And the prompt communication between the patient and the clinician
- The individual should seek adequate emergency care for severe manifestations, or both.
Despite the adherence to an optimal asthmatic chronic care, it is increasingly recognized that some patients need emergency office visits or for them to visit the emergency department (ED) for further care to the patient.
Treatment of Exacerbations of Asthma
1. Pre-hospital care
The Panel of Experts recommends that the Emergency Medical Service Providers (EMS) should administer additional oxygen and inhaled short-acting bronchodilators to all patients who show signs or symptoms of asthma exacerbation as a disease.
EMS providers should have a standing order to allow them to provide albuterol to patients with asthma exacerbation, which is consistent with their scope of practice permitted by law and local medical guidelines.
They should also have a nebulizer, an inhaler, a holding chamber, or both for the administration of ß2-agonists. If there are no possibilities of a ß2-agonists treatment, subcutaneous epinephrine or terbutaline may also be administered for severe exacerbations.
In ED, the severity of asthma exacerbation determines the intensity of treatment and frequency of patient monitoring.
In general, the main treatment (e.g., oxygen administration, inhaled β2 agonists and system corticosteroids) is the same for all exacerbations of asthma or asthma exacerbations, but the dose and frequency of administration, as well as the frequency at which patients are being monitored, differ and depends on the severity of the exacerbations.
In addition, there are three primary treatments, treatment with ipratropium bromide for inhalation or other agents may also be required in other severe exacerbations.
Oxygen administration is recommended by a mask or through nasal cannulae to maintain the SaO2 over 90% (> 95% of pregnant women and patients with concomitant heart disease).
Oxygen saturation should be monitored until there is a clear response to the bronchodilator treatment.
Short-acting β2 agonists inhaled.All patients should be treated with inhaled β2-agonists because repeated or continuous administration of these agents is most effective in reversing airway obstruction.
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