The Science Journal of the American Association for Respiratory Care

Reviews, Overviews, & Updates

February 2002 / Volume 47 / Number 2 / Page 167

Practical Management of Acute Asthma in Adults

Teal S Hallstrand MD MPH and John V Fahy MD

Introduction
Epidemiology
Pathogenesis
Clinical Assessment
Acid-Base Issues and Hypoxemia
Beta Adrenergic Agonists
Anticholinergics
Corticosteroids
Methylxanthines
Leukotriene Modifiers
Magnesium Sulfate
Assessment of the Response to Therapy
Heliox
Noninvasive Ventilation
Mechanical Ventilation
General Anesthesia
Follow-Up
Summary
All asthma patients are at risk for acute asthma exacerbations. Moderate to severe exacerbations account for many emergency department visits and subsequent hospitalizations each year. Recent studies have advanced our understanding of the pathogenesis and treatment of acute asthma. The purpose of this review is to provide practical guidance in the assessment and treatment of adults with acute asthma in the hospital setting. Managing patients with acute asthma involves assessing the severity of the exacerbation, implementing measures to rapidly reverse airflow limitation, and instituting therapies that limit the progression of airway inflammation. Some patients may benefit from other supportive measures such as heliox and noninvasive ventilation. If the patient continues to deteriorate and requires mechanical ventilation, then ventilator settings that minimize the risk of hyperinflation should be chosen. After an episode of acute asthma, long-term preventive medications, especially inhaled corticosteroids, should be prescribed and education should be provided to prevent future episodes.
Key words: Key words: asthma, status asthmaticus, acute severe asthma, beta adrenergic agonist, anticholinergic, leukotriene, corticosteroid, mechanical ventilation, heliox, noninvasive ventilation.
[Respir Care 2002;47(2):171–182]

Introduction

Asthma exacerbations account for over 1.8 million emergency department visits each year in the United States. Recent advances in our understanding of the pathogenesis of asthma and studies evaluating the effectiveness of therapies for acute asthma have led to improvements in acute asthma management. During the evaluation of a patient with acute asthma, the clinician should be able to assess the severity of the exacerbation, implement measures that will rapidly reverse airflow obstruction, and initiate anti-inflammatory therapy that will prevent the progression of airflow limitation and prevent relapse of the exacerbation. The purpose of this review is to provide practical guidance for the assessment and treatment of adults with acute asthma in the emergency department and hospital settings. This is not meant to be an all-inclusive review of the literature on acute asthma, but rather it is meant to highlight information likely to prove useful to the clinician making decisions regarding the management of an individual patient. The evidence provided in this review is based on studies of the pathophysiology of acute asthma and on clinical trials evaluating the efficacy of therapeutic interventions.

The entire text of this article is available in the printed version of the February 2002 RESPIRATORY CARE.

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