![]() ![]() Inhaled short-acting beta 2 agonists are the cornerstones of treatment for acute asthma.Īn inhaler with a spacer is equivalent to nebulized short-acting beta 2 agonist therapy in children and adults.Ĭontinuous beta 2 agonist administration reduces hospital admissions in patients with severe acute asthma. 5 Other risk factors for developing an asthma exacerbation include allergen triggers (e.g., pets, seasonal allergens, smoke exposure) and improper use of medications (e.g., not using a spacer, improper use of an inhaler or other delivery device). ![]() 4 However, regular monitoring of PEF does not help predict an asthma exacerbation. 3 In adults, variables associated with relapse within eight weeks of an asthma exacerbation include three or more visits for emergent care in the preceding six months, difficulty performing daily activities because of physical health in the preceding four weeks, and patient self-discharge from care within 24 hours of hospital admission without achieving 50 percent predicted peak expiratory flow (PEF). One study of children up to 18 years of age presenting to the emergency department with acute asthma symptoms identified multiple risk factors for a subsequent emergency department visit: age younger than two years, black race or Hispanic ethnicity, persistent asthma, public health insurance, lower asthma quality-of-life scores, and increased use of the health care system during the previous 12 months. Airway inflammation can persist for days to weeks after an acute attack therefore, more intensive treatment should be continued after discharge until symptoms and peak expiratory flow return to baseline. The administration of systemic corticosteroids within one hour of emergency department presentation decreases the need for hospitalization, with the most pronounced effect in patients with severe exacerbations. Intravenous magnesium sulfate has been shown to significantly increase lung function and decrease the necessity of hospitalization in children. Multiple doses of inhaled anticholinergic medication combined with beta 2 agonists improve lung function and decrease hospitalization in school-age children with severe asthma exacerbations. In the ambulatory and emergency department settings, the goals of treatment are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse. Administration using a hand-held metered-dose inhaler with a spacer device is at least equivalent to nebulized beta 2 agonist therapy in children and adults. In patients with a peak expiratory flow of 50 to 79 percent of their personal best, up to two treatments of two to six inhalations of short-acting beta 2 agonists 20 minutes apart followed by a reassessment of peak expiratory flow and symptoms may be safely employed at home. Criteria for exacerbation severity are based on symptoms and physical examination parameters, as well as lung function and oxygen saturation. He was transferred to the intensive care unit, where he did well, and was subsequently discharged without sequelae.Asthma exacerbations can be classified as mild, moderate, severe, or life threatening. Cardiopulmonary resuscitation, including chest compressions and medications, was required to resuscitate him. She immediately returned to the examination room where she witnessed the patient suffering respiratory arrest and progressing to cardiac arrest. ![]() She stepped out of the examination room to verify dosages of medication, when she heard him call for help. It was 300 mL, significantly better than his usual measurements. He was doing well, in fact better than his usual baseline, and his physician measured his peak expiratory flow in the office. His vital signs were blood pressure 110/79 mm Hg, pulse rate 76 per minute and oxygen saturation 90 percent on room air. He was in the office for routine follow-up and adjustment of medications. Almost 10 years earlier, he was treated for a positive purified protein derivative test with six months of isoniazid therapy, but he has no other medical problems besides asthma. The patient, a 41-year-old man, is well known in our office. ![]()
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