What are the criteria for asthma exacerbation?

From the Guidelines

Asthma exacerbation is defined as an acute or subacute episode of progressive increase in asthma symptoms, associated with airflow obstruction, and is characterized by worsening of one or more of the asthma symptoms such as cough, wheezing, chest tightness, and dyspnea.

Criteria for Asthma Exacerbation

The criteria for asthma exacerbation include:

• Symptoms: worsening of asthma symptoms such as cough, wheezing, chest tightness, and dyspnea
• Airflow obstruction: decrease in lung function as measured by FEV1 or PEF
• Need for rescue medications: increased need for rescue medications such as bronchodilators
• Hospitalization: hospitalization or emergency department visit due to asthma exacerbation

Classification of Asthma Exacerbation Severity

The severity of asthma exacerbation can be classified as:

• Mild: symptoms are mild and can be managed at home
• Moderate: symptoms are moderate and may require treatment and monitoring in the emergency department
• Severe: symptoms are severe and require hospital admission
• Life-threatening: symptoms are life-threatening and require immediate medical attention According to the Global Initiative for Asthma 1, asthma exacerbations are episodes of acute or subacute worsening in symptoms and lung function. The American Thoracic Society/European Respiratory Society statement 1 recommends that the definition of severe exacerbations should include at least 3 days' use of systemic corticosteroids. The Expert Panel Report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1 state that asthma exacerbations are characterized by decreases in expiratory airflow and that objective measures of lung function are more reliable indicators of severity than symptoms. The National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations 1 classify the severity of asthma exacerbations based on symptoms, signs, and functional lung assessment.

From the Research

Definition of Asthma Exacerbation

• The definition of "asthma exacerbation" is proposed as "a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome" 2
• The most widely used definitions of exacerbation include three components:
  • Systemic use of corticosteroids
  • Asthma-specific emergency department visits or hospitalizations
  • Use of short-acting β-agonists as quick-relief medications 2

Classification of Asthma Exacerbations

• Asthma exacerbations can be classified as mild, moderate, severe, or life-threatening based on symptoms and physical examination parameters, as well as lung function and oxygen saturation 3
• The severity of exacerbations can be determined by peak expiratory flow, symptoms, and lung function 3, 4

Criteria for Exacerbation Severity

• Criteria for exacerbation severity include:
  • Peak expiratory flow of 50 to 79 percent of personal best
  • Symptoms such as wheezing, coughing, and shortness of breath
  • Physical examination parameters such as lung sounds and oxygen saturation
  • Use of short-acting β-agonists and systemic corticosteroids 3, 4
• The presence of exacerbations is an important defining characteristic of asthma severity 5

Management of Asthma Exacerbations

• Management strategies for acute asthma exacerbations include:
  • Use of short-acting β-agonists and systemic corticosteroids
  • Administration of inhaled anticholinergic medication and beta2 agonists
  • Use of intravenous magnesium sulfate in severe cases
  • Continued treatment after discharge to prevent relapse 3, 4, 5