Acute asthma exacerbations: an overview

Authors

  • Domenico Lorenzo Urso U.O. Pronto Soccorso-Medicina d’Urgenza – Ospedale Civile “N. Giannettasio” Rossano (CS)

DOI:

https://doi.org/10.7175/rhc.v5i3.932

Keywords:

Asthma, Exacerbations, Guidelines

Abstract

Asthma is a chronic inflammatory disease of the airways. All patient with asthma are at risk of having exacerbations characterized by worsening symptoms, airflow obstruction, and an increased requirement for rescue bronchodilators. Asthma exacerbations can be classified as mild, moderate, severe, or life threatening. The goals of treatment are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse.

References

Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med 2006; 355: 2226-35; http://dx.doi.org/10.1056/NEJMra054308

Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA), 2012. Available at: http://www.ginasthma.org

National Institutes of Health, National Heart, Lung and Blood Institute National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, 2007. Available at http://www.nhlbi.nih.gov/guidelines/asthma/

BTS, British Thoracic Society Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. Thorax 2008; 63(Suppl iv): 1-121; http://dx.doi.org/10.1136/thx.2008.097741

Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009; 180: 59-99; http://dx.doi.org/10.1164/rccm.200801-060ST

Tattersfield AE, Postma DS, Barnes PJ, et al. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group. Am J Respir Crit Care Med 1999; 160: 594–9; http://dx.doi.org/10.1164/ajrccm.160.2.9811100

Kolbe J, Fergusson W, Garret J. Rapid onset asthma: a severe but uncommon manifestation. Thorax 1998; 53: 241-7; http://dx.doi.org/10.1136/thx.53.4.241

Weiss KB, Sullivan SD, Lyttle CS. Trend in the cost illness for asthma in the United States 1985- 1994. J Allergy Clin Immunol 2000; 106: 493- 9; http://dx.doi.org/10.1067/mai.2000.109426

Bai TR, Von KJM, Postma DS, et al. Severe exacerbations predict excess lung function decline in asthma. Eur Resp J 2007; 30: 452-6; http://dx.doi.org/10.1183/09031936.00165106

Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: a review. Chest 2004; 125: 1081-102; http://dx.doi.org/10.1378/chest.125.3.1081

Urso DL. Treatment for acute asthma in the Emergency Department: practical aspects. Eur Rev Med Pharmacol Sci 2010; 14: 209-14

Rowe BH, Voaklander DC, Wang D, et al. Asthma presentations by adults to emergency departments in Alberta, Canada: a large population-based study. Chest 2009; 135: 57-65; http://dx.doi.org/10.1378/chest.07-3041

Weber EJ, Silverman RA, Callaham ML, et al. A prospective multicenter study of factors associated with hospital admission among adults with acute asthma. Am J Med 2002; 113: 371-8; http://dx.doi.org/10.1016/S0002-9343(02)01242-1

Braman SS, Kaemmerlen JT. Intensive care of status asthmaticus: a 10-years experience. JAMA 1990; 264: 366-8; http://dx.doi.org/10.1001/jama.264.3.366

Moorman JE, Rudd RA, Johnson CA, et al; Centers for Disease Control and Prevention (CDC). National surveillance for asthma – United States, 1984-2004. MMWR Surveill Summ 2007; 56: 1-54

Göksel O, Celik GE, Erkekol FO, et al. Triggers in adult asthma: are patients aware of triggers and doing right? Allerg Immunopathol 2009; 37: 122-8; http://dx.doi.org/10.1016/S0301-0546(09)71723-9

Harrison BD. Difficult asthma in adult: recognition and approaches to management. Intern Med J 2005; 35: 543-7; http://dx.doi.org/10.1111/j.1445-5994.2005.00901.x

Hodder R, Lougheed MD, Rowe BH, et al. Management of acute asthma in adult in the emergency department: non ventilator management. CMAJ 2010; 182: 265-72; http://dx.doi.org/10.1503/cmaj.080072

Proceeding of the ATS Workshop on Refractory Asthma. Am J Respir Crit Care Med 2000; 162: 2341-51; http://dx.doi.org/10.1164/ajrccm.162.6.ats9-00

20.Urso DL, Vincenzo D, Pignataro F, et al. Diagnosis and treatment of refractory asthma. Eur Rev Med Pharmacol Sci 2008; 12: 315-320

Bousquet J, Cabrera P, Berkman N, et al. The effect of treatment with omalizumab, an anti-IgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma. Allergy 2005; 60: 302-8; http://dx.doi.org/10.1111/j.1398-9995.2004.00770.x

Haldar P, Pavord ID, Show DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Resp Crit Car Med 2008; 178: 218-24; http://dx.doi.org/10.1164/rccm.200711-1754OC

Restrepo RD, Peters J. Near-fatal asthma: recognition and management. Curr Opin Pulm Med 2008; 14: 13-23; http://dx.doi.org/10.1097/MCP.0b013e3282f1982d

Roy SR, Milgron H. Management of the acute exacerbation of asthma. J Asthma 2003; 40: 593-604

Lazarus SC. Emergency treatment of asthma. N Engl Med J 2010; 363: 755-64; http://dx.doi.org/10.1056/NEJMcp1003469

Gervais P, Larouche I, Blais L, et al. Asthma management at discharge from the emergency department: a descriptive study. Can Respir J 2005; 12: 219-22

Silverman Ra, Flaster E, Enright PL, et al. FEV1 performance among patients with acute asthma. Chest 2007; 131: 164-71; http://dx.doi.org/10.1378/chest.06-0530

Rodrigo GJ, Rodriquez Verde M, Peregalli V, et al. Effects of short-term 28% and 100% oxygen on PaCO2 and peak expiratory flow rate in acute asthma: a randomized trial. Chest 2003; 124: 1312-7; http://dx.doi.org/10.1378/chest.124.4.1312

Cates CJ, Crilly JA, Rowe BH. Holding chambre (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2006; 2: CD000052

Camargo CA Jr, Spooner CH, Rowe BH. Continous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev 2003; 4: CD001115

Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax 2005; 60: 740-6; http://dx.doi.org/10.1136/thx.2005.047803

32.Gelb AF, Karpel J, Wise RA, et al. Bronchodilator efficacy of the fixed combination of ipratropium and albuterol compared to albuterol alone in moderate-to-severe persistent asthma. Pulm Pharmacol Ther 2008; 21: 630-6; http://dx.doi.org/10.1016/j.pupt.2008.02.005

Fiel SB, Vincken W. Systemic corticosteroid therapy for acute asthma exacerbations. J Asthma 2006; 43: 321-31; http://dx.doi.org/10.1080/02770900600567163

Rowe BH, Spooner C, Ducharme FM, et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rew 2001: CD002178

Rodrigo G, Rodrigo C. Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation. Chest 1999; 116: 285-95; http://dx.doi.org/10.1378/chest.116.2.285

Edmonds ML, Camargo CA, Pollack CV, et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rew 2003: CD002308

Parameswaran K, Belda J, Rowe BH. Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database Syst Rev 2000; CD002742

Urso DL, Luchetti L. Efficacia e sicurezza dei farmaci broncodilatatori nel paziente anziano affetto da bronco pneumopatia cronica ostruttiva (BPCO). G Geront 2005; 53: 73-5

Dalhen SE. Treatment of asthma with antileukotrienes: first line or last resort therapy? Eur J Pharmacol 2006: 533: 40-56; http://dx.doi.org/10.1016/j.ejphar.2005.12.070

Montuschi P. Role of leukotrienes and leukotriene modifiers in asthma. Pharmaceutical 2010; 3: 1792-811

Kluitert LME, Watson D. Antileukotrienes as adjunctive therapy in acute asthma. Drug 2007; 67: 1665-70; http://dx.doi.org/10.2165/00003495-200767120-00002

Urso DL, Vincenzo D, Formaro F, et al. Role of antileukotrienesin acute asthma exacerbations. Review in Health Care 2012; 3: 75-81

Rowe BH, Spooner C, Ducharme FM, et al. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000; 4: CD001490

Rodrigo G, Pollack C, Rodrigo C, et al. Heliox for nonintubated acute asthma patients. Cochrane Database Syst Rev 2006; 4: CD002884

Ram FS, Wellington S, Rowe BH, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev 2005; CD004360

Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest 2003; 123: 1018-25; http://dx.doi.org/10.1378/chest.123.4.1018

FitzGerald JM. The management of acute life-threatening asthma. Eur Respir Monit 2003; 23: 396-408

Aldington S, Beasley R. Asthma exacerbations: Assessment and management of severe asthma in adults in hospital. Thorax 2007; 62: 447-58; http://dx.doi.org/10.1136/thx.2005.045203

49.Rowe BH, Spooner CH, Ducharme FM, et al. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev 2007; CD000195

Downloads

Published

2014-07-31

Issue

Vol. 5 No. 3 (2014)

Section

Narrative reviews

License

Authors who publish with this journal agree to the following terms:
  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
  4. Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)