The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

Treatment of Acute Asthma in the ER

Timothy R. Myers BS, RRT Rainbow Babies & Children's Hospital, Cleveland, Ohio

Asthma is a chronic inflammatory disease with components of airway responsiveness and airflow obstruction that has an increasing economic and social impact on today's fiscally strapped health care system. Despite recent advances in therapeutic management of asthma, it is one of the most common chronic conditions in the United States. Recent estimates predict that asthma affects 15 million Americans, one-third of which are children under 18 years of age. While asthma prevalence has been increasing in all age groups, asthma prevalence in children has increased at a much faster rate than their adult counterparts.1
While the disease of asthma is a wide-ranging problem, it does not affect all groups of people equally. While asthma in Third World countries is a disease of the wealthy, in the United States it is a disease that affects minorities and socioeconomically deprived populations living in the inner cities. Hospitalizations and emergency room visits are all too common for high-risk asthmatics at or below the poverty level. The Center for Disease Control estimates that in 1995 there were 1.867 million visits to the emergency room by asthmatics (570,000 by children under 14 years of age).1
In late 1991 and again in 1997, the NIH and NAEPP release Asthma guidelines to assist in the diagnosis and management of asthma.2,3 While many clinicians consider asthma an ambulatory care sensitive condition and ED visits and hospitalizations as indicators of failure of ambulatory or preventative care, the reasons for visits to the ED for asthma are complex, and include numerous factors.
This lecture will briefly review the management of acute asthma exacerbations according to the NIH Asthma Guidelines. This lecture will also take closer look at protocols, therapies and medications that may or may not be useful in the management of emergency room asthma as described in recent publications
1 Mannino DM, Homa DM, Pertowski CA et al: Surveillance for Asthma -- United States, 1960-1995. MMWR Morb Mortal Wkly Rep 47:1-26, 1998.
2 National Heart, Lung, and Blood Institute: International Consensus Report on Diagnosis and Management of Asthma. NIH Publication No. 92-3091. Bethesda, National Institutes of Health, 1992.
3 Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education Program, National Heart, Lung and Blood Institutes of Health, 1997.

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