Practical management of acute asthma in adults.
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.
Hallstrand
Teal S
TS
Division of Pulmonary and Critical Care Medicine, University of Washington, Box 356522, Seattle WA 98195-6522, USA. tealh@u.washington.edu
Fahy
John V
JV
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002985:Clinical Protocols; D006801:Humans; D012121:Respiration, Artificial; D014481:United States / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists