From the Guidelines
The management of acute asthma exacerbation involves early treatment with a written asthma action plan, increasing the dose of short-acting beta-agonists (SABAs), and adding a short course of oral systemic corticosteroids 1.
Key Components of Management
- Assessment and monitoring: Evaluate the severity of the exacerbation using objective measures of lung function, such as spirometry or peak expiratory flow (PEF) 1.
- Patient education: Instruct patients on how to recognize early indicators of an exacerbation, adjust their medications, and monitor their response to treatment 1.
- Environmental control: Remove or withdraw from allergens or irritants in the environment that may contribute to the exacerbation 1.
- Medications:
- SABAs: Increase the dose as needed to control symptoms 1.
- Systemic corticosteroids: Use a short course (3-10 days) to reduce inflammation and prevent recurrence 1.
- Inhaled corticosteroids (ICSs): Can be started at any point in the treatment of an asthma exacerbation, but doubling the dose is not effective 1.
Treatment in the Emergency Department
- Primary treatment: Administer oxygen, inhaled beta-2 agonists, and systemic corticosteroids, with the dose and frequency of administration dependent on the severity of the exacerbation 1.
- Additional therapies: Consider heliox-driven albuterol nebulization, inhaled ipratropium bromide, or other agents in severe exacerbations 1.
- Ventilator management: Consult with a physician expert in ventilator management, and consider "permissive hypercapnia" or "controlled hypoventilation" as a ventilator strategy 1.
From the Research
Management of Acute Asthma Exacerbation
The management of acute asthma exacerbation involves several key components, including:
- Prompt recognition and rapid reversal of airflow obstruction to avert relapses and future episodes 2
- Use of short-acting beta-agonists, oxygen, and corticosteroids as the basis of management 2, 3
- Consideration of anticholinergics and newer agents such as levalbuterol and formoterol 2
- Initiation or intensification of long-term controller therapy, treatment of comorbid conditions, avoidance of likely triggers, and timely follow-up care to prevent setbacks 2
Treatment Strategies
Treatment strategies for acute asthma exacerbation may include:
- First-line therapy consisting of oxygen supplementation, repeated administration of inhaled short-acting bronchodilators (beta-2-agonists and ipratropium bromide), and early systemic glucocorticosteroids 3
- Second- and third-line treatment strategies, such as intravenous magnesium sulphate and aminophylline, for poorly responding patients 3
- Intensive care for severe asthma that is not responsive to first-line treatment 3, 4
- Extracorporeal life support (ECLS) as an advanced non-pharmacologic therapy for critically ill adult asthmatic patients 4
Prevention of Exacerbations
Prevention of exacerbations is also an important aspect of managing acute asthma, and may involve:
- Avoidance of allergens, viral infections, occupational exposures, and air pollution 5, 6
- Treatment of comorbid diseases 6
- Patient education and cooperation, including compliance to therapy, inhalation techniques, and written asthma plans 6
- Use of inhaled steroids and combined treatments as the most effective preventive therapy for exacerbations 6