Chest
ReviewsAcute Asthma in Adults: A Review
Section snippets
Epidemiology and Costs
AA is a common medical emergency faced by ED and intensive care specialists. In the United States, asthma represents the 11th most frequent ED diagnosis nationwide, and adolescents and young adults are the most likely age groups to visit the ED for treatment.11 Women visit the ED and are hospitalized for AA twice as often as men.1213 Previous data suggested that 40% of these hospitalizations occur during the premenstrual phase of the cycle.14 Men are less likely than women to report severe
Pathophysiology
Different triggers cause asthma exacerbations by inducing airway inflammation or provoking acute bronchospasm or both. Triggers vary from person to person and from time to time. Exposure to indoor and outdoor allergens, air pollutants, respiratory tract infections (primarily viral), exercise, weather changes, foods, additives, drugs, and extreme emotional expressions are the main triggers identified clinically. Other factors that may cause exacerbations are rhinitis, bacterial sinusitis,
Fatal Asthma
In many countries, asthma mortality increased from the 1960s to the second half of the 1980s, but reached a plateau and has subsequently declined.5455565758 This recent downward trend may reflect better management of this condition in primary care. Asthma has a low mortality rate compared with other lung diseases, but mortality does occur, typically in patients with poorly controlled disease whose condition gradually deteriorates over a period of days or even weeks before the fatal attack.596061
Assessment
AA is a medical emergency that must be diagnosed and treated urgently. The assessment of an asthma exacerbation constitutes a process with two different dimensions: (1) a static assessment to determine the severity of attack, and (2) a dynamic assessment to evaluate the response to treatment. Overall, it requires an analysis of several factors.8283
ICU Management
Many patients admitted to the ICU with AA simply require additional time for the therapies instituted in the ED to be continued and for respiratory function to improve. These patients often require a relatively brief period of time in the ICU; when improvement is clear, they can be discharged to the regular ward. Since it is not clear on ICU admission which patients will pursue such a course, the benefit of the ICU is largely one of careful observation and rapid response to those patients who
Summary
AA is a common medical emergency faced by ED and intensive care physicians. Properly managed, there should be a very low mortality rate; but death does occur, typically in patients with poorly controlled disease whose condition gradually deteriorates over a period of days or even weeks before the fatal event. This observation suggests many patients have a window of opportunity for recognition and reversal of this period of deterioration. The assessment of an asthma exacerbation constitutes a
References (244)
- et al.
Survey of asthma practice among emergency physicians
Chest
(1996) - et al.
Are doctors still failing to asses and treat asthma attacks? An audit of the management of acute attacks in a health district
Respir Med
(1999) - et al.
Asthma severity adequacy of management in accident and emergency departments in France: a prospective study
Lancet
(2001) - et al.
Influence of gender on rates of hospitalization, hospital course, and hypercapnea in high-risk patients admitted for asthma: a 10-year retrospective study at Yale-New Haven hospital
Chest
(2001) - et al.
Differences between men and women in reporting of symptoms during an asthma exacerbation
Ann Emerg Med
(2001) - et al.
Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general
Arch Bronconeumol
(2002) - et al.
A prospective multicenter study of factors associated with hospital admission among adults with acute asthma
Am J Med
(2002) - et al.
Arterial blood gases in bronchial asthma
J Allergy
(1970) - et al.
Blood-gas tensions in bronchial asthma
Lancet
(1967) - et al.
Hypertension intracranienne au cours de l'etat asthmatique
Ann Fr Anesth Reanim
(1987)
Subarachnoid hemorrhage following permissive hypercapnia in a patient with severe acute asthma
Am J Emerg Med
Sudden-onset fatal asthma
Mayo Clin Proc
Rapid-onset asthma attack: a prospective cohort study about characteristics and response to the emergency department treatment
Chest
Decreases in asthma mortality in the United States
Ann Allergy Asthma Immunol
Risk factors for death from asthma
Ann Allergy Asthma Immunol
A community-based study of near-fatal asthma
Ann Allergy Asthma Immunol
Asma casi fatal: ¿entidad clínica o manejo inadecuado?
Arch Bronconeumol
Near-fatal asthma: a population-based study of risk factors
Chest
Determinants of near fatality in acute severe asthma
Am J Med
The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea
Chest
Asthma and panic attacks
Biol Psychiatry
Asthma death confounded by substance abuse: an assessment of fatal asthma
Chest
Prevalence of cocaine use and its impact on asthma exacerbation in an urban population
Chest
Heroin insufflation as a trigger for patients with life-threatening asthma
Chest
Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease
Chest
High-dose MDI salbutamol treatment of asthma in the ED
Am J Emerg Med
Metered dose inhaler salbutamol treatment of asthma in the ED: comparison of two doses with plasma levels
Am J Emerg Med
Assessment of the patient with acute asthma in the emergency department: a factor analytic study
Chest
Position and diaphoresis in acute asthma
Am J Med
Early administration of hydrocortisone in the emergency room treatment of acute asthma: a controlled clinical trial
Respir Med
Treatment of acute asthma: lack of therapeutic benefit and increase of the toxicity from aminophylline given in addition to high doses of salbutamol delivered by metered-dose inhaler with spacer
Chest
Effect of age on bronchodilator response in the acute asthma treatment
Chest
An assessment of peak expiratory flow as a surrogate measurement of FEV1in stable asthmatic children
Chest
Comparison of peak expiratory flow and FEV1admission criteria for acute bronchial asthma
Ann Emerg Med
How accurate are pulse oximeters in patients with acute exacerbations of chronic obstructive airways disease?
Respir Med
NIH Publication 02–3659
Expert panel report 2: Guidelines for the diagnosis and management of asthma
Worldwide variations in the prevalence of asthma symptoms: the international study of asthma and allergies in childhood (ISAAC)
Eur Respir J
Surveillance for asthma: United States, 1960–1995
MMWR Morb Mortal Wkly Rep
Self-report asthma prevalence among adults–United States 2000
MMWR Morb Mortal Wkly Rep
Epidemic asthma
Determinants of management errors in acute severe asthma
Thorax
Ambulatory care visits for asthma: United States, 1993–1994
Adv Data
Sex differences among adults presenting to the emergency department with acute asthma
Arch Intern Med
Relation between phase of menstrual cycle and emergency department visits for acute asthma
Am J Respir Crit Care Med
The cost of asthma in New South Wales
Med J Aust
Direct and indirect costs of asthma in Canada, 1990
Can Med Assoc J
Asthma mortality and hospitalization among children and adults, United States 1980–1993
MMWR Morb Mortal Wkly Rep
Evolving differences in the presentation of status asthmaticus requiring intensive care unit admission [abstract]
Chest
Intensive care of status asthmaticus: a 10-year experience
JAMA
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2019, Revue de Medecine InterneHigh ACT score is not sufficient to reduce the risk of asthma exacerbations in asthma with low lung function
2019, Respiratory MedicineCitation Excerpt :Asthma exacerbations (AEs) are related to decreased lung function, increased mortality, and increased cost burden of healthcare [1].
Serum IgG Concentrations in Adult Patients Experiencing Virus-Induced Severe Asthma Exacerbations
2019, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Asthma is an increasingly common cause of emergency department consultations.7 Twenty percent of patients with asthma have experienced exacerbations requiring treatment within the emergency department or hospitalization and these patients account for more than 80% of the total direct costs of asthma.8 Mortality among patients hospitalized for asthma exacerbations accounts for one-third of all asthma-related deaths.9