From the Guidelines
Acute asthma exacerbation is primarily caused by a combination of factors, including viral respiratory infections, allergens, and irritants, and its management involves a multi-component approach, including assessment and monitoring, patient education, environmental control, and medications.
Causes of Acute Asthma Exacerbation
- Viral respiratory infections
- Allergens
- Irritants
Management of Acute Asthma Exacerbation
Home Management
- Use a written asthma action plan to recognize early signs of exacerbation and adjust medications accordingly 1
- Increase SABA and add oral systemic corticosteroids as needed
- Remove or withdraw from environmental factors contributing to the exacerbation
- Monitor response to treatment and seek medical care if necessary
Urgent or Emergency Care Setting
- Assess severity of exacerbation using lung function measures and symptom assessment 1
- Treat to relieve hypoxemia and airflow obstruction with supplemental oxygen, repetitive or continuous SABA, and oral systemic corticosteroids
- Monitor response to treatment and consider adjunctive treatments such as magnesium sulfate or heliox in severe cases
- Discharge with medication, patient education, and a follow-up plan 1 Key medications for managing acute asthma exacerbation include SABA, oral systemic corticosteroids, and ICS.
- SABA: used for quick relief of symptoms
- Oral systemic corticosteroids: used to reduce airway inflammation
- ICS: used for long-term control of asthma symptoms 1
From the Research
Causes of Acute Asthma Exacerbation
- Asthma exacerbations can occur across a wide spectrum of chronic severity, contributing to millions of emergency department visits every year 2
- The presence of exacerbations is an important defining characteristic of asthma severity, and can be triggered by various factors 3
- Asthma exacerbations are characterized by worsening symptoms, airflow obstruction, and an increased requirement for rescue bronchodilators 4
Management of Acute Asthma Exacerbation
- The best strategy for managing an asthma exacerbation is early recognition and intervention, continuous monitoring, appropriate disposition, and multifaceted transitional care 2
- Short-acting beta-agonists, oxygen, and corticosteroids form the basis of management of acute asthma exacerbation 4, 5
- Anticholinergics and newer agents such as levalbuterol and formoterol may also play a role in management 4
- Initiation or intensification of long-term controller therapy, treatment of comorbid conditions, avoidance of likely triggers, and timely follow-up care can help prevent setbacks 4, 5
- Asthma action plans can help patients triage and manage symptoms at home, and can include the use of inhaled corticosteroid/formoterol combinations or short-acting beta2 agonists 5
Treatment Strategies
- In patients 12 years and older, home management may include an inhaled corticosteroid/formoterol combination or a short-acting beta2 agonist 5
- In children four to 11 years of age, an inhaled corticosteroid/formoterol inhaler can be used to reduce the risk of exacerbations and need for oral corticosteroids 5
- In the office setting, assessment of exacerbation severity and treatment with short-acting beta2 agonists and oxygen is important, with repeated doses of the short-acting beta2 agonist every 20 minutes for one hour and oral corticosteroids 5
- Patients with severe exacerbations should be transferred to an acute care facility and treated with oxygen, frequent administration of a short-acting beta2 agonist, and corticosteroids, with the addition of a short-acting muscarinic antagonist and magnesium sulfate infusion as needed 5